Hearing preserved traumatic delayed facial nerve paralysis without temporal bone fracture: neurosurgical perspective and experience in the management of 25 cases

BackgroundDelayed FNP due to HT is a rarely encountered clinical entity, and optimal treatment still remains to be elucidated.MethodsTwenty-five patients with delayed traumatic FNP without TBF, who had serviceable hearing, were included in our study. Thirteen patients underwent surgical decompression, whereas 12 were managed medically depending on the ENoG findings, which were obtained within the first 3 weeks after the onset of the facial paralysis. Pre- and postmanagement evaluation of the FN function was graded according to HB grading scale.ResultsThe mean follow-up period was 6.5 ± 4.06 years. Complete or nearly complete recovery of FN function had occurred in 66.6% and 76.9% in medically and surgically treated groups, respectively. Most of the patients showed good outcome, and the presented data supports that the choice of treatment in patients with hearing preserved delayed traumatic FNP without TBF depends mainly on the ENoG findings.ConclusionsAlthough timing of surgery in traumatic delayed FNP remains to be elucidated, we think that surgical exploration should be considered if serial ENoG demonstrates more than 90% nerve degeneration.