Whilst the causes of recurrent facial nerve palsy are numerous, in many cases it may be idiopathic. There is no clear consensus on treatment of this condition and conservative management alone may condemn patients to gradually worsening facial nerve function after repeated attacks. This group reports on their series of 12 cases where they have undertaken facial nerve decompression via a middle fossa approach. They selected 18 patients with at least two episodes of facial palsy, 12 received surgery whilst six declined and were treated conservatively.
In the operated group the internal auditory canal segment, meatal foramen, labyrinthine segment and geniculate ganglion were decompressed within three weeks.
Those managed conservatively (control group) received oral prednisolone, 1 mg/kg/d for 10 days. The patients in the surgery group and the control group were followed up for 5.8 and 5.5 years respectively. Facial nerve function was assessed by the House–Brackmann facial nerve grading system. In the operated group, one patient had further episodes of facial palsy on the ipsilateral side, whilst in the control group, 4/6 had further episodes of ipsilateral facial palsy. The initial mean facial nerve function of the surgery group was HB 3.5 and of the control group was HB 3.7 After treatment, 11 patients in the surgery group recovered to Grade I or Grade II, amongst which six patients totally recovered. In contrast, only half of the control group recovered to Grade I or Grade II and the other three cases returned to Grade III or worse level due to further episodes of facial palsy. Hearing was preserved in all patients, and there was no severe complication. This study highlights an invasive, yet effective method to treat recurrent idiopathic facial palsy.
