Neurosurgical Tactics in Fractures of a Temporal Bone and an Injured Facial Nerve

Shirshov I.*, Dreval .*, Lihterman L.**, Gorozhanin .*

* Department of Neurosurgery, Medical Academy of Postgraduate Education, Moscow, Russia;
** Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

A facial nerve injury (FNI) occupies the second place after Bells paralysis. Its rate is 5-20%. A car crash is a cause of this traumatic lesion in 70% of cases. Today there are no generally accepted standards, determining indications for operation, its methods and time.

Material and Methods. There were 64 cases (20.6% in the structure of craniocerebral trauma) with FNI, treated in neurosurgical departments of the Botkin Municipal Clinical Hospital and Municipal Clinical Hospital N 67. Operations were performed in 12 casualties (18.7%) with an injury grade of HBS-L. Diagnostic measures included otoneurological examination, electromyography (EMG), CT of the temporal bone pyramids. EMG was carried out on the 14th and 28th day after FNI. Severity of FNI was estimated on the bases of House-Brackmann scale (HBS), having 5 grades.

Results. All the cases (64) were subjected to intensive conservative treatment. Decompression of the nerve in a canal of the temporal bone pyramid was performed in 9 patients (75%); a transtemporal suprapyramidal access was used (7 cases were operated during 4 weeks after the facial nerve paralysis; intervention was performed 7 weeks after trauma in 1 casualty; one more patient was operated in 4 months due to severity of his condition). The first minimum movements appeared in 7 cases during the first day after operation. It happened during a week in 1 patient. This period was 8 months in a casualty, operated 4 months after trauma. Plasty of the above nerve with a descending branch of the hypoglossal nerve was performed in 3 cases (25%). It was done 5 and more months after FNI. The first conjugate movements appeared 3 months after operation in all the cases. EMG examination demonstrated slow and incomplete reduction of bioelectrical activity deficit.

Conclusion. Thus, operation time, severity of FNI and EMG data were leading factors in making a decision on surgery of the facial nerve. A degree and speed of restoration of the facial nerve function were dependent on operation time.