Facial Nerve Outcomes After Middle Fossa Decompression for Bell’s Palsy

OBJECTIVE: Evaluate the long-term outcomes of facial nerve decompression via the middle fossa approach for Bell's palsy patients with poor prognosis based on clinical and electrodiagnostic testing. STUDY DESIGN: Retrospective case series. SETTING: Tertiary-care, academic medical center. PATIENTS: Fourteen patients underwent surgical decompression for Bell's palsy within 14 days of symptom onset from 2000 to 2012. Surgical criteria included greater than 90% degeneration on ENoG testing and no voluntary EMG potentials. INTERVENTION: Middle cranial fossa (MCF) bony decompression of the facial nerve, including the meatal foramen, labyrinthine segment, and geniculate ganglion. MAIN OUTCOME MEASURES: Long-term facial function, hearing results, and surgical complications. RESULTS: After MCF decompression, 10 patients (71.4%) regained normal or near-normal facial function (House-Brackmann [HB] I or II) within 1 year after surgery, and 5 of those patients (35.7%) improved to HB I. The remaining 4 patients (28.6%) improved to HB III. Patients older than 60 years (n = 3) had an HB III outcome and did significantly worse than the younger-than-60-years group (p = 0.002). The difference in preoperative and postoperative pure tone average and word recognition score was 2.1 dB and 0.9%, respectively. There were no major complications. Minor, transient complications occurred in 22.2% of patients. CONCLUSION: In patients with severe Bell's palsy at risk for a poor facial nerve outcome, MCF decompression of the facial nerve within 14 days of symptom onset provides good facial nerve outcomes with minimal morbidity.