Facial nerve decompression

Facial nerve palsy is usually managed conservatively, but in some cases may require surgical intervention. In cases in which the continuity of the nerve is not disrupted, decompression is the procedure of choice. No reports were found in the literature addressing this group separately. We report the results of 33 facial nerve decompressions conducted in the Sheba Medical Center through the years 1985-2002. Fifteen of our patients were operated on using the middle cranial fossa approach, 12 underwent mastoidectomy and 6 were treated using the combined middle cranial fossa - mastoidectomy approach. Twenty-four (72.7%) underwent surgery for temporal bone fracture and the rest (27.3%) due to other reasons (iatrogenic injury, infection). The postoperative results were determined using the House-Brackmann (HB) scale. Patients who were operated on more than 30 days after complete palsy achieved better results than those operated on earlier than 30 days. The total average HB score was 3.2. The followup results are significantly worse in patients after less than 3 months, as compared to those with 3 to 12 months followup. On the basis of our experience, facial nerve decompression achieves good functional results. We found no advantage in early vs. late intervention with regard to results. The final results can be determined only a year after surgery.