[Facial paralysis during progressive chronic otitis. Reflections apropos of 32 cases]

The authors report their experience of 32 cases of facial paralysis occurring during progressive chronic otitis. Twenty were pre-operative. The conclusions which may be drawn are as follows: 1) It occurs in general in cases of severe chronic otitis with large destructive cholesteatomatous and osteitic lesions. 2) Surgery is often difficult, long full of unexpected findings and risks. 3) The development of facial paralysis in a case of progressive chronic otitis is an indication for immediate surgery, on the same basis as a fistula of the H.S.C.C., which is, in fact, oftan present in association. 4) The lesions encountered are much more extensive at the time of secondary (11) rather than at primary surgery (9). 5) The extent of the lesions (13 cases of fistula or laybrinthine destruction) and auditory impairment (16 cophoses or sub-cophoses) are such that tympanoplasty is useless. The authors report their long term results: 13 cases of complete recovery, 4 nil, 3 partial (2 as a result of a superficial cervical plexus graft). They raise the problem of the management when a markedly contused nerve is discovered: simple liberation with incision of its sheath or immediate graft? The other twelve were postoperative. Five were cases operated upon by the autor. There was 100% recovery in all cases, but one patient, in whom the nerve followed an atypical course, required decompression surgery. In the other seven, the autors performed 3 decompressions followed by an excellent result, apart from in one case in which the nerve was markedly contused. In 2 cases a superficial cervical plexus graft and a XII-VII anastomosis proved necessary.