Abstract
Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell’s palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell’s palsy. Twelve patients underwent surgical decompression for Bell’s palsy 21–70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell’s palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.
Similar content being viewed by others
References
Adour KK (1998) Combination treatment with acyclovir and prednisone for Bell palsy. Arch Otolaryngol Head Neck Surg 124:824
Mantsopoulos K, Psillas G, Psychogios G, Brase C, Iro H, Constantinidis J (2011) Predicting the long-term outcome after idiopathic facial nerve paralysis. Otol Neurotol 32:848–851
Peitersen E (1992) Natural history of Bell’s palsy. Acta Otolaryngol Suppl 492:122–124
May M, Blumenthal F, Klein SR (1983) Acute Bell’s palsy: prognostic value of evoked electromyography, maximal stimulation, and other electrical tests. Am J Otol 5:1–7
Fisch U (1984) Prognostic value of electrical tests in acute facial paralysis. Am J Otol 5:494–498
Gantz BJ, Rubinstein JT, Gidley P, Woodworth GG (1999) Surgical management of Bell’s palsy. Laryngoscope 109:1177–1188
Mancini P, De Seta D, Prosperini L, Nicastri M, Gabriele M, Ceccanti M (2014) Prognostic factors of Bell’s palsy: multivariate analysis of electrophysiological findings. Laryngoscope 124:2598–2605
Canter RJ, Nedzelski JM, McLean JA (1986) Evoked electromyography in Bell’s palsy: a clinically useful test? J Otolaryngol 15:344–347
Fisch U (1981) Surgery for Bell’s palsy. Arch Otolaryngol 107:1–11
Cannon RB, Gurgel RK, Warren FM, Shelton C (2014) Facial nerve outcomes after middle fossa decompression for Bell’s palsy. Otol Neurotol 36:513–518
Yanagihara N, Hato N, Murakami S, Honda N (2001) Transmastoid decompression as a treatment of Bell palsy. Otolaryngol Head Neck Surg 124:282–286
Chow LC, Tam RC, Li MF (2002) Use of electroneurography as a prognostic indicator of Bell’s palsy in Chinese patients. Otol Neurotol 23:598–601
Grosheva M, Guntinas-Lichius O (2007) Significance of electromyography to predict and evaluate facial function outcome after acute peripheral facial palsy. Eur Arch Otorhinolaryngol 264:1491–1495
De Seta D, Mancini P, Minni A, Prosperini L, De Seta E, Attanasio G (2014) Bell’s palsy: symptoms preceding and accompanying the facial paresis. ScientificWorldJournal 2014:801971
Sugita T, Murakami S, Yanagihara N, Fujiwara Y, Hirata Y, Kurata T (1995) Facial nerve paralysis induced by herpes simplex virus in mice: an animal model of acute and transient facial paralysis. Ann Otol Rhinol Laryngol 104:574–581
Adour KK (2002) Decompression for Bell’s palsy: why I don’t do it. Eur Arch Otorhinolaryngol 259:40–47
McAllister K, Walker D, Donnan PT, Swan I (2013) Surgical interventions for the early management of Bell’s palsy. Cochrane Database Syst Rev 10:CD007468
Mechelse K, Goor G, Huizing EH, Hammelburg E, Bolhuis AH, Staal A (1971) Bell’s palsy: prognostic criteria and evaluation of surgical decompression. Lancet 2:57–59
Adour KK, Swanson PJ Jr (1971) Facial paralysis in 403 consecutive patients: emphasis on treatment response in patients with Bell’s palsy. Trans Am Acad Ophthalmol Otolaryngol 75:1284–1301
Grogan PM, Gronseth GS (2001) Practice parameter: steroids, acyclovir, and surgery for Bell’s palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 56:830–836
Acknowledgments
This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIP) (No. 2011-0030072).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Rights and permissions
About this article
Cite this article
Kim, S.H., Jung, J., Lee, J.H. et al. Delayed facial nerve decompression for Bell’s palsy. Eur Arch Otorhinolaryngol 273, 1755–1760 (2016). https://doi.org/10.1007/s00405-015-3762-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-015-3762-y