Surgical Reconsideration of Traumatic Facial Paralysis

Area of Science:

• Neurosurgery
• Otolaryngology
• Neurology

Background:

• Traumatic facial paralysis requires careful assessment for surgical intervention.
• Electrophysiological criteria, like electroneurography (ENoG), are crucial in decision-making.
• Distinguishing traumatic paralysis from Bell's palsy is essential for appropriate treatment.

Purpose of the Study:

• To evaluate the efficacy of preoperative electroneurography (ENoG) in guiding surgical timing for traumatic facial paralysis.
• To compare surgical exploration versus conservative treatment based on ENoG results and time of intervention.
• To identify optimal surgical windows for patients with severe traumatic facial paralysis.

Main Methods:

• Analysis of 517 patients with traumatic facial paralysis and a degenerative ratio (DR) > 80% on ENoG.
• Patients were categorized into two groups based on DR: Group A (≥90%) and Group B (80-90%).
• Outcomes were assessed using the House-Brackmann grading system, comparing surgery with conservative management at different surgical time points.

Main Results:

• Surgical exploration led to better facial paralysis recovery than conservative treatment in both groups.
• Significant improvement was observed for Group A patients undergoing surgery within 8 days.
• Group B patients showed significant benefits from surgery within 16 days, and even up to 20 and 30 days post-onset.

Conclusions:

• ENoG is valuable in assessing the need for surgical exploration in traumatic facial paralysis.
• Optimal surgical timing varies based on the severity of nerve degeneration (DR).
• Timely surgical intervention can significantly improve functional outcomes in traumatic facial paralysis.