Treatment of Traumatic Lesions of a Facial Nerve

I.A. Shirshov, O.N. Dreval, L.B. Likhterman, A.V. Gorozhanin

(Faculty of Neurosurgery of the Russian Medical Academy of Postgraduate Education, Moscow;
Burdenko Research Institute of Neurosurgery, Moscow;
Botkin Municipal Clinical Hospital, Moscow)

Traumatic lesions of a facial nerve occupy the second place as a cause of paralysis. They yield the palm to Bellsís paralysis and are watched in 5-20% of cases. It should be mentioned, that 70% of them are the result of crashes. Patients, aged 10-30, account for 60-70% of traumatic lesions of the facial nerve.

As for clinical practice, severity of such lesions is usually underestimated. Treatment is often unsystematic and tardy, which leads to incomplete reinnervation of the nerve. Surgical treatment is limited to plastic operations. In its turn, it has a considerable negative effect on efficacy of restoration of the nerve function. Today a choice of an optimum method is the most difficult problem, as there are no common standards, determining indications for an operation, its time and volume.

There were 61 cases with clinical signs of the facial nerve injury, treated in the neurosurgical department of the Botkin State Clinical Hospital. A diagnostic algorithm included otoneurological and electromyographic examinations, CT of the temporal bone pyramids with 3D-reconstruction of the facial nerve canal. A degree of its traumatic lesion was estimated on the basis of House-Brackmann five-grade scale. On admission all the patients were subject to multimodality conservative therapy, accompanied by blockades of the stellate ganglion. Gross paresis (7 cases) was treated by decompression of the nerve in the temporal bone canal, using a transtemporal suprapyramidal extradural approach. Plasty of the facial nerve with a descending branch of the accessory nerve was performed in 3 of them. Indications for surgery of the facial nerve were based on data of electromyographic examination. Dynamic examination was carried out on the 14th-20th day after trauma. It was repeated in 2 weeks. Plastic operations were made in a remote period of the facial nerve trauma (5 months and more) due to delayed admission of patients to our clinic.

The proposed method of examination and multimodality treatment of the facial nerve trauma had certain advantages over other existing methods. It allowed to carry out an objective assessment of the nerve state, dynamics of a clinical picture of motor disorders and to choose a necessary method of treatment, ensuring the best possible result.