Massachusetts Eye and Ear Infirmary, Massachusetts
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the prevalence and surgical outcomes of middle fossa decompression for recurrent facial nerve palsy.
Objectives: To investigate the surgical outcomes in patients treated for recurrent facial nerve palsy (RFP) at a quaternary facial nerve referral center. Study Design: Retrospective case control study.
Methods: A retrospective chart review was performed on 132 patients with RFP who presented to our institution's facial nerve clinic from 2001-2021. Records were analyzed for etiology of palsy, facial nerve function and recurrence rates. Pre and postoperative audiometric outcomes were also assessed in surgically managed patients.
Results: 248 patients with RFP were identified, and 132 patients met criteria to be surgical decompression candidates. Of these, 6.8% underwent surgical decompression. For patients who did not undergo surgery, the House-Brackmann (HB) score was 2.9 ┬▒ 1.3 (SD) at the initial clinic visit, and 2.4 ┬▒ 1.3 (SD) at the last clinic visit. This difference was significantly different (p = 0.01, t-test). For surgical patients, the preoperative HB score was 2.9 ┬▒ 0.9 (SD) and postoperative HB score was 1.8 ┬▒ 0.6 (SD), which were significantly different (p = 0.01, t-test). The number of facial palsy episodes also decreased pre and postoperatively from 3.5 ┬▒ 0.8 (SD) to 0.2 ┬▒ 0.4 (SD) episodes, which were significantly different (p <0,001, t-test). There were no significant differences in the starting facial nerve function between nonsurgical and surgical groups (p = 0.91, t-test). Audiometric outcomes were not significantly different pre- and post-surgery (p=0.31, t-test for PTA; p=0.34, t-test for WRS).
Conclusions: Facial nerve decompression for RFP patients with incomplete functional recovery may be an effective treatment for decreasing the frequency and severity of facial palsy episodes.