[Facial paralysis after temporal bone trauma].

OBJECTIVES: To evaluate functional outcome in 64 cases of facial paralysis following temporal bone fracture and discuss decisive arguments leading either to medical treatment or surgical management.

METHODS: Sixty-four patients suffering from post-traumatic facial paralysis were managed between 1995 and 2003: 38 (59%) were given medical treatment and 26 (41%) underwent surgery. A combined middle fossa and transmastoid approach was mostly used (58%). Electrophysiological testing and CT scan results were the main points of the decision algorithm.

RESULTS: Electroneuromyography seems to be the most accurate exploration for guiding treatment. Good results (grades I to II on the House and Brackmann scale) were obtained in 63% of cases after medical management and in 39% of cases after surgical treatment. Grades III or IV were obtained in 13% of medically-treated patients and 42% of surgically-treated patients.

CONCLUSION: Management of facial paralysis following temporal bone fracture in accordance with electrophysiological testing (evoked EMG) together with CT scan findings enabled accurate indications for surgical treatment. A good grade I or II result can be expected after medical management. A grade III is at best reached after nerve anastomosis.