Surgery or Watchful Waiting? Dilemma in Managing Facial Palsy Following Temporal Bone Fracture

Abstract

Introduction: Post-traumatic facial nerve paralysis (FNP) is challenging, often leaving surgeons in a dilemma between conservative management and surgical intervention. This study was done to evaluate the clinical outcome of FNP resulting from temporal bone fracture (TBF).

Material and Methods: A prospective observational study was conducted on patients with radiologically confirmed TBF.  FNP was identified in 51 cases and graded using House-Brackmann grading system.

Results: Of the 69 cases included in the study, 51 patients exhibited FNP. 34 patients were included in immediate onset (21/34 had indeterminate onset) group and 17 patients were included in delayed onset group. All patients received oral corticosteroids initially. Follow-ups were conducted at 15, 30, 90 and 180 days.  Seven patients who showed no signs of reinnervation on electromyography at day 30 were advised to undergo surgical intervention. Only three patients opted for facial nerve (FN) decompression, while four declined surgery. At six-month follow-up, 49 patients (including two post-surgical cases) demonstrated following outcomes: 26 patients improved to HB grade I, 15 to grade II, five to grade III, two to grade IV, and one to grade V. Among the three patients who underwent FN decompression, two improved from grade V-IV to grade III. Of four patients who refused surgery, three remained at HB grades IV-V. Over extended follow-up, one patient deteriorated to grade VI by 54 weeks, while the other two improved to grade II by 64 and 70 weeks, respectively.

Conclusion: Immediate onset post-traumatic FNP has the potential for spontaneous recovery without surgical decompression.