Facial nerve outcomes after middle fossa decompression for bell's palsy

Objective Evaluate the long-term outcomes of facial nerve decompression via the middle fossa approach for Bell's palsy patients with poor prognosis based on clinical and electrodiagnostic testing. Study Design Retrospective case series. Setting Tertiary-care, academic medical center. Patients Fourteen patients underwent surgical decompression for Bell's palsy within 14 days of symptom onset from 2000 to 2012. Surgical criteria included greater than 90% degeneration on ENoG testing and no voluntary EMG potentials. Intervention Middle cranial fossa (MCF) bony decompression of the facial nerve, including the meatal foramen, labyrinthine segment, and geniculate ganglion. Main Outcome Measures Long-term facial function, hearing results, and surgical complications. Results After MCF decompression, 10 patients (71.4%) regained normal or near-normal facial function (House-Brackmann [HB] I or II) within 1 year after surgery, and 5 of those patients (35.7%) improved to HB I. The remaining 4 patients (28.6%) improved to HB III. Patients older than 60 years (n = 3) had an HB III outcome and did significantly worse than the younger-than-60-years group (p = 0.002). The difference in preoperative and postoperative pure tone average and word recognition score was 2.1 dB and 0.9%, respectively. There were no major complications. Minor, transient complications occurred in 22.2% of patients. Conclusion In patients with severe Bell's palsy at risk for a poor facial nerve outcome, MCF decompression of the facial nerve within 14 days of symptom onset provides good facial nerve outcomes with minimal morbidity.