Evaluation And Management Of Immediate Posttraumatic Facial Nerve Palsy At Sir T Hospital, Tertiary Care Centre In Bhavnagar

Abstract

: Background: Facial nerve palsy following trauma, is an uncommon condition which occurs in
1.5% patients of skull base fractures, majority of them due to road traffic accidents causing temporal bone
fractures. Indication and timing of facial nerve decompression for facial paralysis and anatomical extent of
decompression has been a subject of controversy for years. The aim of this study is to present prospective
review of 10 patients with immediate facial paralysis after trauma that underwent either surgical
decompression of facial nerve via trans mastoid approach or conservative management. Objectives-To
know age and sex wise distribution of immediate posttraumatic facial nerve palsy and to know most
common grade of presentation according to H-B scale and most common type of temporal bone fractures
and segment of facial nerve involved. To study outcome (within 1 month) of various modes of management
of immediate posttraumatic facial nerve palsy. Material And Methods: After approval from ethics
committee, this prospective cross-sectional study was carried out in 10 patients presented with immediate
facial nerve palsy due to trauma at ENT department of Sir T Hospital, Bhavnagar over a period of 1 year
from July 2022 to June 2023. After taking consent, proper history was taken and time of RTA and time of
presentation at ENT OPD was separately noted. Patients were examined and graded using House and
Brackman grading system. All the patients were evaluated and treated either by conservative management
(Injectable steroids with facial physiotherapy) or surgical decompression via trans mastoid approach.
Result: Most common age group involved was the young adolescents (20-30years) who are more prone to
RTA and traumatic injuries. Numbers of males affected were more than females in our study. Tympanic
segment of facial nerve was found to be involved in maximum number of patients. Patients with transverse
fracture of temporal bone causing immediate posttraumatic facial palsy were found to have better
prognosis with surgical decompression. Patients with longitudinal fracture of temporal bone can go for
either conservative management or if no improvement found within 7days were taken for surgical
decompression of facial nerve via trans mastoid approach. Most of the patients who were managed
surgically were found to have better prognosis according to this study. Conclusion: We draw the conclusion
from our study that early diagnosis and surgical intervention significantly improved prognosis for
immediate facial palsy following trauma. The trans mastoid approach for facial nerve decompression can be
utilized when trauma is clearly localized to the tympanic or mastoid segment of facial nerve. Transverse
fracture of temporal bone should be always treated with immediate surgical decompression and in
longitudinal fractures both conservative and surgical management plays an important role. Appropriate
post-operative management with oral steroids and physiotherapy plays an important role in traumatic
facial nerve palsy. [AK Natl J Integr Res Med, 2023; 14(4):11-15, Published on Dated: 8/07/2023]