Subtemporal—supralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture

Objective To investigate the clinical outcomes of facial nerve decompression via a subtemporal-supralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Sixteen patients with unilateral facial paralysis due to temporal bone fracture were graded as having House-Brackmann Grades Ⅲ in 4, Ⅴ in 9 and Ⅵ in 3. The preoperative mean air conduction threshold was 52 dB in 13 cases with longitudinal temporal bone fracture and serious sensorineral hearing loss in 3 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. After an intact canal wall mastoido- epitympanectomy, the ossicular chain damage was evaluated. If the ossicular chain was intact, the supralabyrinthine recess was opened by drilling through the cells between the tegmen tympani and ossicular chain; if the ossicular chain was interrupted, then the incus was removed and the supralabyrinthine recess was directly opened. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, a dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 13 cases of longitudinal fractures, the greater petrosus nerves were damaged in 3 cases, bleeding was found in 5 cases, an interrupted ossiclular chain in 9 cases, a dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 and fracture of the incus long process in 1. In 3 trasverse fractures, a dehiscence on the promontory, semicircular canal and oval window was founded. 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 recovereyed to House-Brackmann GradesⅠin 9,Ⅱ in 5 and Ⅲ in 2. Overall air conduction pure tone averages improved 33 dB. Conclusion The clinical outcomes concerning the facial nerve function and hearing recovery are satisfactory via a subtemporal- supralabyrinthine approach to geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis .