Endoscopic Facial Nerve Regeneration Surgery for Bell’s Palsy

By June 7, 2019

Goto, Takanari1; Ito, Tsukasa1; Furukawa, Takatoshi1; Kubota, Toshinori1; Matsui, Hirooki1; Abe, Yasuhiro1; Sugiyama, Motoyasu1; Kakehata, Seiji1
1 Department of Otolaryngology Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.

We treated patients with severe Bell’s palsy with a high-dose steroid protocol combined with a facial nerve regeneration treatment with basic fibroblast growth factor (bFGF) performed using transcanal endoscopic ear surgery (TEES) and compared our results to patients treated by a high-dose steroid protocol only.

Study Design: Prospective clinical study

Setting: Tertiary referral center

Patients: Fifty-five patients with Bell’s palsy and ENoG value of 5% or less with all patients treated following a high-dose steroid protocol out of which 16 patients further underwent endoscopic facial nerve regeneration treatment using bFGF within 2 months from onset.

Intervention: All patients were administered prednisolone (PSL) + Hespander + Mannitol with PSL started at 200 mg/d and tapered to 10 mg/d over a 10-day period. The TEES/bFGF group also underwent surgery during which the facial nerve of the tympanic segment was exposed, and a tube was placed by the exposed nerve. bFGF was injected daily through the tube for 8 days.

Main Outcome Measure(s): The recovery rate was compared between the TEES/bFGF and high-dose steroid only groups.

Results: The complete recovery rate for the TEES/bFGF group was 62.5% which was significantly higher than the rate of high-dose steroid group at 21.2%. The complete recovery rate for TEES/bFGF patients with an ENoG value greater than 0% was 88.9% (n=9) and with an ENoG value of 0% was 28.6% (n=7).

Endoscopic facial nerve regeneration surgery using bFGF should become an important treatment option for patients with severe Bell’s palsy.