[Postoperative facial nerve function outcomes and influencing factors in petrous apex cholesteatoma: a Meta-analysis]

Objective: To systematically evaluate postoperative facial nerve function outcomes and to identify prognostic factors in patients with petrous apex cholesteatoma(PBC) through meta-analysis. Methods: Literatures published publicly from the establishment of databases to September 2025 regarding peripheral facial paralysis secondary to petrous bone cholesteatoma (PBC) were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Medical Journal Full-text Database, PubMed, EMBASE, Web of Science, and Cochrane Library. Meta-analysis was performed on studies meeting the inclusion criteria to explore postoperative facial nerve function and its prognostic influencing factors of PBC patients. Statistical pooled analyses were conducted using Stata 17 and RevMan 5.3 software. Results: A total of 742 literatures were initially retrieved in this study, among which 50 eligible studies were finally included after screening, consisting of 26 English articles and 24 Chinese articles. The pooled improvement rate of postoperative facial nerve function in patients with peripheral facial paralysis secondary to PBC was 53% (95%CI: 44%-62%), and the postoperative deterioration rate of facial paralysis was 2% (95%CI: 0%-5%). For PBC patients with preoperative House-Brackmann (HB) grade I facial nerve function, the retention rate of HB grade I facial nerve function after surgery reached 91% (95%CI: 85%-97%).Patients with a facial paralysis duration of ≥1 year had a significantly lower improvement rate of facial nerve function compared with those with a disease duration of <1 year (OR=0.06, 95%CI: 0.03-0.11, P<0.01). Patients with severe preoperative facial paralysis showed a markedly lower rate of postoperative recovery to HB grade Ⅲ or higher than those with mild-to-moderate preoperative facial paralysis (OR=0.36, 95%CI: 0.18-0.71, P=0.003). The postoperative facial nerve improvement rate was significantly lower in PBC patients with incomplete facial nerve integrity than in those with intact facial nerves (OR=0.07, 95%CI: 0.02-0.30, P=0.000 3). No statistically significant difference was observed in the postoperative facial nerve improvement rate after PBC resection between patients with facial nerve lesions at the labyrinthine segment and above and those with lesions below the labyrinthine segment (OR=0.84, 95%CI: 0.18-3.88, P=0.83). Conclusions: Among patients with PBC-induced peripheral facial paralysis, the postoperative facial nerve improvement rate was 53%, facial paralysis aggravation rate 2%, and grade I facial nerve preservation rate 91%. Prognostic risk factors for postoperative facial nerve function following PBC resection included paralysis duration ≥ 1 year, severe preoperative facial paralysis, and facial nerve discontinuity.