Facial nerve decompression for idiopathic Bell's palsy: report of 13 cases and literature review

INTRODUCTION: The prognosis for cases of idiopathic facial palsy is usually good. However, some cases develop disabling sequelae, such as synkinesis or severe facial hemispasm, despite targeted medical treatment. OBJECTIVES: The authors try to achieve that electromyography is useful to identify patients with severe palsy and an unfavourable prognosis. These patients would probably benefit from facial nerve decompression. SETTING: The otolaryngology-head and neck surgery department of Pitié-Salpêtrière Hospital, Paris, a tertiary referral centre. PARTICIPANTS: Thirteen cases undergoing surgery between January 1997 and March 2007. MAIN OUTCOME MEASURES: We describe the electromyographic findings that led to surgery. All patients underwent surgery via a subpetrous approach, within four months of the onset of palsy. Decompression involved the first and second portions of the nerve and the geniculate ganglion. RESULTS: Recovery to House-Brackmann grade III was obtained in all cases at one year follow up. CONCLUSION: These results compared favourably with previous reports. A new therapeutic procedure may allow improved results.