Changing Trends in Managing Facial Nerve Paralysis Secondary to Temporal Bone Fractures: Our Institutional Experience

Aim: The aim of the present study is to share our experience in managing high-grade posttraumatic facial nerve paralysis using both surgical as well as nonsurgical approaches. Materials and Methods: A retrospective analysis of 31 cases of high-grade (House-Brackmann [HB]: V/VI) facial nerve paralysis following undisplaced temporal bone fracture treated at our tertiary care hospital between 2016 and 2019 was done. Patients' assessment included clinical, audiological, computer tomography scans, and electromyography (EMG) evaluation. Fourteen of the cases presenting between February 2016 and November 2017 underwent surgical decompression of the facial nerve based on our prevailing institutional protocol during that period. However, the next 17 patients presenting between January 2018 and May 2019 were managed conservatively on the basis of our surgical experience in managing such patients before this period and some contemporary data suggesting good results with conservative management, using oral steroids and facial physiotherapy. The patients were assessed clinically and using EMG at 4 weekly intervals as a standard institutional protocol. Results: Among the 14 patients who underwent surgical decompression, lesions were predominantly found in the perigeniculate region. Analysis of results after 12 months revealed 86% (12 out of 14) of cases who underwent surgery had a satisfactory recovery (HB Grade I-II). A satisfactory recovery was achieved in 94% (16 out of 17) of conservatively managed patients (HB Grade I-II). However, there was no statistically significant difference identified between the outcomes of the two groups. Conclusion: The outcome of patients presenting with high-grade facial paralysis with unfavorable EMG findings secondary to undisplaced temporal bone fractures is generally good with or without surgical intervention. The recovery may take around 2-3 months to initiate. We recommend giving nonsurgical conservative management to such patients with regular clinical and electrophysiological monitoring. Clinical Significance: The outcomes and our experience of managing such cases may be useful for clinicians in deciding the course of action in patients presentin