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Gunshot wounds to the facial nerve
Ricardo F Bento1, Rubens V de Brito
1Department of Otolaryngology, University of São Paulo Medical School, São Paulo, Brazil. rbento@attglobal.net
Objective:
This paper presents our experience with gunshot wounds to the temporal bone and discusses facial nerve lesions, surgical indication, surgical timing, and other findings.
Study Design:
We performed a retrospective review of patients treated for facial nerve lesion after gunshot injury to the temporal bone.
Setting:
The study was performed in the Otolaryngology Department of the University of Sao Paulo Medical School, Sao Paulo, Brazil.
Patients:
Ninety-eight patients treated between 1988 and 1999 were analyzed.
Intervention:
Facial nerve lesions, bullet locations, and surgical techniques were analyzed. Patients were monitored for 2 years.
Results:
Gunshot trauma to the temporal bone presented considerable tissue loss resulting from the abrasion effect and severity of the impact. The third segment of the facial nerve was most affected, and the bullet was typically found lodged in the mastoid tip. Postoperative infection was common. Such cases required revision surgery, resulting in worse cosmetic outcomes than in cases of closed trauma.
Conclusions:
Surgical exploration of the facial nerve should be performed as soon as possible, since long delays increase the chance of traumatic neuroma and more pronounced scarring around the facial nerve. Open mastoidectomy with meatoplasty is the surgical technique recommended for repairing the mastoid and the facial nerve. In the majority of cases, a cable graft is necessary. Since nerve lesion in proximity to the stylomastoid foramen and extratemporal facial nerve is common, these areas must be explored carefully.