Surgical and nonsurgical treatment outcomes in traumatic facial nerve palsy.

PURPOSE: Facial nerve decompression surgery is performed on patients with immediate, complete traumatic facial palsy. However, the clinical advantage of the surgical treatment has weak evidence because of lack of control groups in previous studies. Therefore, this study compared facial function outcomes between the patients who underwent surgery and those who did not. Furthermore, in cases of bilateral traumatic facial palsy, the outcomes of the surgical and nonsurgical sides were also discussed. METHODS: A retrospective medical chart review of immediate and severe (House-Brackman [HB] grade V and VI) traumatic facial palsy was conducted. Twenty-five ears from the surgical group and eight ears from the conservative treatment group were enrolled. Among the patients, three with immediate and severe bilateral facial palsy underwent unilateral surgery. RESULTS: The average HB grade after 1-year follow-up was 1.7 in the surgical group and 1.5 in the nonsurgical group. Four patients who have definite facial canal disruption in the imaging study have recovered to HB grades I-III without surgical intervention. In patients with bilateral facial palsy, the nonsurgical side showed the same or better facial functions than the surgical side. CONCLUSIONS: Compared with nonsurgical conservative treatment, facial nerve decompression surgery did not show superior outcomes in immediate HB grade V-VI traumatic facial palsy. The clinical advantage of facial nerve decompression is questionable and should be re-evaluated in a prospectively designed study.