Endoscopic transcanal facial
nerve decompression provides a less traumatic and improved exposure
of the geniculate ganglion, and may also help prevent permanent
severe facial sequela, suggests a recent study conducted at the
Department of Otolaryngology Head and Neck Surgery, Shanghai 9th
People’s Hospital affiliated to Shanghai Jiaotong University School
of Medicine, Shanghai, China.
research is published in the American Journal of Otolaryngology.
Zhili Wang and colleagues
explored the surgical effects of endoscopic facial nerve
decompression in Bell’s palsy.
The authors carried out a
retrospective study which included a total of 15 patients with Bell’s
palsy. All had grade VI (House-Brackmann grading system) complete
unilateral facial paralysis before surgery and a >95% reduction in
amplitude on electroneurography testing compared to the unaffected
Their MRI results indicated
perineural edema in the geniculate ganglion area. Endoscopic
decompression surgery was performed soon after they presented at our
The time between onset of facial
paralysis and surgery ranged from 25 to 93 days. All patients had no
relevant surgical history or ear diseases.
The study revealed that at 1-year
follow-up, 13 of the 15 (87%) patients had recovered to normal or
near-normal facial function (House-Brackmann grade I-II), and all
patients had reached House-Brackmann grade III or lower facial
function. No obvious air-bone gap or sensorineural hearing loss
occurred after surgery, and there were no severe complications or
Hence, the authors concluded that
endoscopic transcanal facial nerve decompression provides a less
traumatic and improved exposure of the geniculate ganglion, and may
also help prevent permanent severe facial sequela.
They further inferred that the
results of intraoperative facial nerve stimulation may be related to
the length of time required for recovery. The optimal time of surgery
after onset of paralysis needs to be investigated further, to
identify a post-drug surgical therapy which may be more acceptable
for patients. Patients’ response to conservative treatments should be
assessed as soon as possible so as not to delay surgery.
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