[Temporal bone transverse fracture and peripheric facial paralysis: our surgical approach and results]

In this study, our surgical approaches in temporal bone transvers fracture cases with facial paralysis and their results were evaluated.

Five temporal bone transverse fracture cases (2 females, 3 males; mean age 32.8 years; range 4 to 62 years) with facial paralysis which were treated in our clinic between July 1998 and July 2008 were included in this study. Radiologic, audiologic, topographic and electrodiagnostic investigations were made preoperatively. The evaluation of facial nerve function was performed by using House-Brackmann (HB) classification. Tympanic segment, ganglion geniculi and labyrinthine segment were exposed by translabyrinthine approach in all cases. Integrity of the facial nerve was achieved via re-routing and end-to-end anastomosis or n. auricularis major interpositional graft. The cases were evaluated regarding complications and facial nerve function postoperatively.

In the audiologic investigation ipsilateral total neurosensorial hearing loss was determined in all cases. In four cases facial paralysis was recognized immediately and in one patient it was recognized when the patient was discharged from the intensive care unit. Facial nerve function was HB stage V in all cases. Surgery was performed in the first six weeks and it was observed that integrity of the labyrinthine segment was distorted in all cases. Reconstruction was performed by re-routing and end-to-end anastomosis in three cases and n. auricularis major interpositional graft in two cases. There were no postoperative complications. Facial nerve function was HB stage II in three cases (re-routing) and HB stage III in two cases (graft).

In temporal bone fracture cases with neurosensorial hearing loss and facial paralysis, we achieved good exposure via translabyrintine approach. Better functional results were obtained in re-routing and end-to-end anastomosis technique when compared to interpositional grafting.