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Journal of Korean Neurosurgical Society 1990;19(2): 241-246.
Significance of the Decompression of the Facial Canal in Patient with Traumatic Facial Paralysis.
S W Jo, H K Rha, G S Lee, M S Ahn, C R Choi, J U Song
Department of Neurosurgery, Catholic University Medical College, Seoul, Korea.
Of 9 patients with facial paralysis following closed head injury, 6 cases were treated operatively at neurosurgical department of Catholic Medical College in recent 2 years. 8 of 9 cases were male and 4 cases were third decade. Three cases were showed immediate onset and 6 cases were delayed paralysis. Associated symptoms and signs were temporal bone fracture : 8 cases, battle's sign : 6 cases, C.S.F. otorrhea : 5 cases, hearing impairment : 4 cases, epidural hematoma : 2 cases, and brain contusion : 1 case. We have used the Schimer test, the Stapedius reflex test and Electrogustrometry to determine the topographic site of lesion and also have used nerve stimulator and E.M.G. to determine the extent of nerve involvement. Outcome of the operated patients was generally good. Of 6 patients who underwent facial canal decompression, 5 cases were excellent or good results and one was fair. We suggest that. 1) Facial paralysis of the immediate onset, especially coinciding with C.S.F. otorrhea or temporal bone fracture should be treated by operative exploration of the facial nerve as soon as the patients general condition has stabilized. 2) The patient who has temporal bone fracture, C.S.F. otorrhea or battles sign should be closely observed for the delayed development of facial paralysis. 3) In case of delayed type of facial weakness, it is better to be decompressed as soon as possible when the paralysis is dense, but close observation with percutaneous nerve excitability test for several days is recommended when the paralysis is partial. If the weakness is progressive or axonal degeneration is suspected on percutaneous nerve excitability test, decompression of the facial nerve might be considered for the patient.
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