Facial Nerve Decompression After Temporal Bone Fracture-The Bangalore Protocol

Area of Science:

• Otolaryngology
• Neurosurgery
• Trauma Surgery

Background:

• Facial weakness and paralysis are common after motor vehicle crashes.
• Tertiary otology centers manage these complex cases.
• Established protocols are crucial for effective treatment.

Purpose of the Study:

• To evaluate a specific management protocol for facial nerve paralysis post-trauma.
• To assess the efficacy of surgical decompression using a transcanal approach.
• To report outcomes in patients treated between 1998 and 2017.

Main Methods:

• Retrospective review of 141 patients with grade 4+ facial weakness undergoing decompression.
• Utilized oral steroids, serial evaluations, and a transcanal approach for decompression.
• Audiometry, physical exams, Schirmer's tests, and CT scans were used for evaluation.

Main Results:

• Mean House-Brackmann (HB) score improved from HB5 to HB2 post-operatively.
• 80% of patients achieved HB1 or HB2 at 6 months.
• 84% of patients with perigeniculate fractures showed improved air conduction levels.

Conclusions:

• The Bangalore protocol effectively improves facial function and conductive hearing loss.
• The transcanal surgical technique aids in identifying fractures and reconstructing ossicles.
• This approach avoids the need for craniotomy in managing traumatic facial nerve injuries.