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Facial nerve decompression for idiopathic Bell's palsy: report of 13 cases and literature review

Published online by Cambridge University Press:  02 October 2009

C Bodénez ,
I Bernat ,
J-C Willer ,
P Barré ,
G Lamas  and
F Tankéré
C Bodénez*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Pitié-Salpêtrière Hospital, Paris, France
I Bernat
Affiliation:
Department of Clinical Neurophysiology, Pitié-Salpêtrière Hospital, Paris, France
J-C Willer
Affiliation:
Department of Clinical Neurophysiology, Pitié-Salpêtrière Hospital, Paris, France
P Barré
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Pitié-Salpêtrière Hospital, Paris, France
G Lamas
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Pitié-Salpêtrière Hospital, Paris, France
F Tankéré
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Pitié-Salpêtrière Hospital, Paris, France
*
Address for correspondence: Dr Camille Bodénez, Department of Otolaryngology – Head and Neck Surgery, Pitié-Salpêtrière Hospital, 47–83 Bd de l'Hôpital, 75651 Paris Cédex 13, France. Fax: 331 42 16 31 05 E-mail: [email protected]
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Abstract

Introduction:

The prognosis for cases of idiopathic facial palsy is usually good. However, some cases develop disabling sequelae, such as synkinesis or severe facial hemispasm, despite targeted medical treatment.

Objectives:

The authors try to achieve that electromyography is useful to identify patients with severe palsy and an unfavourable prognosis. These patients would probably benefit from facial nerve decompression.

Setting:

The otolaryngology – head and neck surgery department of Pitié-Salpêtrière Hospital, Paris, a tertiary referral centre.

Participants:

Thirteen cases undergoing surgery between January 1997 and March 2007.

Main outcome measures:

We describe the electromyographic findings that led to surgery. All patients underwent surgery via a subpetrous approach, within four months of the onset of palsy. Decompression involved the first and second portions of the nerve and the geniculate ganglion.

Results:

Recovery to House–Brackmann grade III was obtained in all cases at one year follow up.

Conclusion:

These results compared favourably with previous reports. A new therapeutic procedure may allow improved results.

Keywords

Facial ParalysisOtologic Surgical ProceduresBell's Palsy
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 3 , March 2010 , pp. 272 - 278
Copyright
Copyright © JLO (1984) Limited 2009

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References

1McCormick, DP. Herpes simplex virus as a cause of Bell's palsy. Lancet 1972;i:937–9CrossRefGoogle Scholar
2Kettel, K. Pathology and surgery of Bell's palsy. Laryngoscope 1963;73:837–49CrossRefGoogle ScholarPubMed
3Linder, T, Bossart, W, Bodmer, D. Bell's palsy and herpes simplex virus: fact or mystery? Otol Neurotol 2005;26:109–13Google Scholar
4Furuta, Y, Aizawa, H, Ohtani, F, Sawa, H, Fukuda, S. Varicella-zoster virus DNA level and facial paralysis in Ramsay Hunt syndrome. Ann Otol Rhinol Laryngol 2004;113:700–5CrossRefGoogle ScholarPubMed
5Honda, N, Hato, N, Takahashi, H, Wakisaka, H, Kisaki, H, Murakami, S et al. Pathophysiology of facial nerve paralysis induced by herpes simplex virus type 1 infection. Ann Otol Rhinol Laryngol 2002;111:616–22Google ScholarPubMed
6Sugita, T, Murakami, S, Yanagihara, N, Fujiwara, Y, Hirata, Y, Kurata, T. Facial nerve paralysis induced by herpes simplex virus in mice: an animal model of acute and transient facial paralysis. Ann Otol Rhinol Laryngol 1995;104:574–81CrossRefGoogle ScholarPubMed
7Furuta, Y, Takasu, T, Fukuda, S, Sato-Matsumura, KC, Inuyama, Y, Hondo, R et al. Detection of varicella-zoster virus DNA in human geniculate ganglia by polymerase chain reaction. J Infect Dis 1992;166:1157–9CrossRefGoogle ScholarPubMed
8Liston, S, Kleid, S. Histopathology of Bell's palsy. Laryngoscope 1989;99:23–6CrossRefGoogle ScholarPubMed
9Jackson, CG, Johnson, GD, Hyams, VJ, Poe, DS. Pathologic findings in the labyrinthine segment of the facial nerve in a case of facial paralysis. Ann Otol Rhinol Laryngol 1990;99:327–9Google Scholar
10McKeever, P, Proctor, B, Proud, G. Cranial nerve lesions in Bell's palsy. Otolaryngol Head Neck Surg 1987;97:326–7Google ScholarPubMed
11Fisch, U, Esslen, E. Total intratemporal exposure of the facial nerve. Arch Otolaryngol 1972;95:335–41CrossRefGoogle ScholarPubMed
12Fisch, U. Surgery for Bell's palsy. Arch Otolaryngol 1981;107:1–11CrossRefGoogle ScholarPubMed
13O'Donogue, GM, Michaels, L. Histopathological aspects of Bell's palsy. In: Portmann, M, ed. Proceedings of the Fifth International Symposium on the Facial Nerve. New York: Masson Publishing USA, 1985;248–52Google Scholar
14Sittel, C, Stennert, E. Pronostic value of electromyography in acute peripheral facial nerve palsy. Otol Neurotol 2001;22:100–4CrossRefGoogle Scholar
15Martin-Duverneuil, N, Sola-Martinez, MT, Miaux, Y, Cognard, C, Weil, A, Mompoint, D et al. Contrast enhancement of the facial nerve on MRI: normal or pathological? Neuroradiology 1997;39:207–12CrossRefGoogle ScholarPubMed
16Charachon, R, Bebear, JP, Sterkers, O, Magnan, J, Soudant, J. Facial palsy – Hemifacial spasm [in French]. Paris: 1997Google Scholar
17Brandle, P, Satoretti-Schefer, S, Bohmer, A, Wichmann, W, Fisch, U. Correlation of MRI, clinical, and electroneuronographic findings in acute facial nerve palsy. Am J Otol 1996;17:154–61Google ScholarPubMed
18Kress, B, Griesbeck, F, Stippich, C, Bähren, W, Sartor, K. Bell's palsy: quantitative analysis of MR imaging data as a method of predicting outcome. Radiology 2004;230:504–9Google Scholar
19Sennaroglu, L. Petrous anatomy for middle fossa approach. Laryngoscope 2003;113:332–42Google Scholar
20Adour, KK. Decompression for Bell's palsy: why I don't do it. Eur Arch Otorhinolaryngol 2002;259:40–7CrossRefGoogle ScholarPubMed
21Friedman, RA. The surgical management of Bell's palsy: a review. Am J Otol 2000;21:139–44CrossRefGoogle ScholarPubMed
22Grogan, P, Gronseth, G. Practice parameter: steroids, acyclovir, and surgery for Bell's palsy (an evidence based review). Neurology 2001;56:830–6CrossRefGoogle ScholarPubMed
23May, M, Klein, S, Taylor, F. Idiopathic (Bell's) facial palsy: natural history defies steroid or surgical treatment. Laryngoscope 1985;95:406–9CrossRefGoogle ScholarPubMed
24Yanagihara, N, Hato, N, Murakami, S, Honda, N. Transmastoid decompression as treatment of Bell palsy. Otolaryngol Head Neck Surg 2001;124:282–6CrossRefGoogle ScholarPubMed
25Sullivan, FM, Swan, IR, Donnan, PT, Morrison, JM, Smith, BH, McKinstry, B et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med 2007;357:1598–607CrossRefGoogle ScholarPubMed
26Engström, M, Berg, T, Stjernquist-Desatnik, A, Axelsson, S, Pitkäranta, A, Hultcrantz, M et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2008;7:993–1000CrossRefGoogle ScholarPubMed
27Hato, N, Yamada, H, Kohno, H, Matsumoto, S, Honda, N, Gyo, K et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol 2007;28:408–13Google Scholar
28Yanagihara, N, Gyo, K, Yumoto, E, Tamaki, M. Transmastoid decompression of the facial nerve in Bell's palsy. Arch Otolaryngol 1979;105:530–4CrossRefGoogle ScholarPubMed
29Gantz, B, Rubinstein, JT, Gidley, P, Woodworth, GG. Surgical management of Bell's palsy. Laryngoscope 1999;109:1177–88CrossRefGoogle ScholarPubMed
30May, M, Blumenthal, F, Taylor, FH. Bell's palsy: surgery based upon prognostic indicators and results. Laryngoscope 1981;91:2092–105CrossRefGoogle ScholarPubMed
31Lejeune, D, Bernat, I, Vitte, E, Lamas, G, Willer, JC, Soudant, J et al. Treatment of Bell's palsy with acyclovir and methylprednisolone. Ann Otolaryngol Chir Cervicofac 2002;119:209–15Google Scholar
32Brown, JS. Bell's palsy: a 5 years review of 174 consecutive cases: an attempted double blind study. Laryngoscope 1982;92:1369–73CrossRefGoogle Scholar
33Pulec, JL. Bell's palsy: diagnosis, management and results of treatment. Laryngoscope 1974;84:2119–40CrossRefGoogle ScholarPubMed
34Knox, GW. Treatment controversies in Bell's palsy. Arch Otolaryngol Head Neck Surg 1998;124:821–3Google Scholar
35Ge, XX, Spector, GJ. Labyrinthine segment and geniculate ganglion of facial nerve in fetal and adult human temporal bones. Ann Otol Rhinol Laryngol 1981;90(suppl 85):1–12CrossRefGoogle ScholarPubMed
36Lee, HK, Lee, WS. Microsurgical anatomy of the perigeniculate ganglion area as seen from the middle cranial fossa approach. Ann Otol Rhinol Laryngol 2003;112:531–3CrossRefGoogle ScholarPubMed
37Devriese, PP. Experimental facial nerve decompression in the cat. Arch Otolaryngol 1972;95:350–5CrossRefGoogle ScholarPubMed
38Gantz, BJ, Gmur, A, Fisch, U. Intraoperative evoked electromyograph in Bell's palsy. Am J Otolaryngol 1982;3:273–8Google Scholar