[Management of post-traumatic facial paralysis. Apropos of 83 cases]

The authors report a series of 83 cases of post-traumatic facial paralysis. This study shows that 65% of paralysis are related to traffic accidents. In 76% of the cases, the deficit is immediate. The initial clinical evaluation evidences a majority of grade V (68%). The auditive impairment is related in 48% of the cases to transmission deafness, in 41% of the cases, there is impairment of the inner ear; lastly for 11% of the patients, hearing is preserved. The electromyography analyses the gravity of the facial nerve impairment: in 47 cases, clear-cut denervation can be noted. Lastly, for 11% of the patients, hearing is preserved. The electromyography analyses the gravity of the facial nerve impairment: in 47 cases clear cut denervation can be noted. Lastly, the electromyography is supplemented by a scan of the temporal bone which defines the type of fracture. Out of 83 patients, 14 labyrinthine fractures were found. Based on the various tests, the therapeutic decision led to 31 medical treatments and 52 surgical procedures. The latter were performed within a 15-day to 2-month time period for 83% of the patients. The type of surgery depends on the supposed lesional site: 31 mixed approaches (middle fossa and transmastoidal), 15 transmastoidal approaches and 6 tranlabyrinthine approaches. Impairment of the geniculate ganglion is quite frequent. Most often, an edema or a confused aspect is found. Sections are rarer (7 cases). The results are excellent for impairment treated non-surgically. In the surgically treated patients, prognosis is more uncertain, especially if a nerve graft is required.(ABSTRACT TRUNCATED AT 250 WORDS)