[Facial nerve decompression through transmastoid, extralabyrinthine, subtemporal approach for management of facial paralysis in temporal bone fracture].

OBJECTIVE: To investigate the clinical outcomes of facial nerve decompression via transmastoid, extra labyrinthine,subtemporal approach for management of facial paralysis in temporal bone fracture. METHOD: Twenty-six cases of traumatic facial paralysis (House-Brackmann grade III-V) hospitalized between January 2006 and April 2008 received facial nerve decompression surgery. There were 4 patients diagnosed as House-Braekmann Grade III, 12 as Grade V in and 10 as Grade VI. The preoperative mean air conduction threshold was 52 dB in 16 cases with longitudinal temporal bone fracture and serious sensorineural heating loss in 10 cases with transverse temporal bone fracture. The fracture lines were detected in 13 cases by temporal bone axial CT scans and ossicular disruption could be determined in 9 cases by virtual endoscopy. The geniculate ganglion,the tympanic and mastoid segment of the facial nerve displayed an irregular morphology in curved planar reformation images of the facial nerve canal. RESULT: All cases had primary healing and no complication occurred. At following-up times ranging from 0.5 to 3 years (average 1.2 years), facial nerve function recovered to House-Brackmann Grades I in 15, II in 6, III in 5. Overall air conduction pure tone averages improved 33 dB. CONCLUSION: Facial nerve decompression with rebuilding of ossicular chain through transmastoid, extralabyrinthine, subtemporal approach is a good approach for the treatment of facial paralysis in temporal bone fracture.