NDLI: Surgical management and the prognosis of iatrogenic facial nerve injury in middle ear surgery: a 20-year experience

Content Provider	Springer Nature : BioMed Central
Author	Sun, Jianbin Wang, Ruoya Chen, Xingrui Wang, Jianze Liu, Da Sai, Na Zhu, Yuhua Liu, Jun Shen, Weidong Dai, Pu Yang, Shiming Han, Dongyi Han, Weiju
Abstract	Background Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments. Methods Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed. Results Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery (P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery (P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III. Conclusions Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.
Related Links	https://head-face-med.biomedcentral.com/counter/pdf/10.1186/s13005-023-00377-y.pdf
Ending Page	14
Page Count	14
Starting Page	1
File Format	HTM / HTML
DOI	10.1186/s13005-023-00377-y
Journal	Head & Face Medicine
Issue Number	1
Volume Number	19
Language	English
Publisher	BioMed Central
Publisher Date	2023-07-25
Access Restriction	Open
Subject Keyword	Otorhinolaryngology Oral and Maxillofacial Surgery Dentistry Head and Neck Surgery Facial nerve paralysis Middle ear surgery Iatrogenic injury Facial nerve repair
Content Type	Text
Resource Type	Article
Subject	Otorhinolaryngology Neurology (clinical) Dentistry
Journal Impact Factor	2.4/2023
5-Year Journal Impact Factor	2.9/2023

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