Total Transcanal Endoscopic Facial Nerve Decompression for Bell’s Palsy and Traumatic Facial Nerve Palsy

By June 7, 2019

Zhaoyan Wang 1,2,3, Yongchuan Chai 1,2,3, Weidong Zhu 1,2,3, Zhihua Zhang 1,2,3, Huan Jia 1,2,3, Lingxiang Hu1,2,3, Hao Wu 1,2,3
1 Department of Otolaryngology Head & Neck surgery, Shanghai Ninth people’s Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China;
2 Ear institute, Shanghai Jiaotong University School of Medicine,Shanghai, China;
3 Shanghai Key Laboratary of Translational Medicine on Ear and Nose disease, Shanghai, China.

Bell’s palsy and temporal bone trauma are common causes of facial nerve palsy. This study is to evaluate the application of total transcanal endoscopic approach for minimally invasive facial nerve decompression in patients with Bell’s palsy and traumatic tacial nerve palsy.

A total of 9 patients (4 Bell’s palsy and 5 traumatic facial nerve palsy) undergone facial nerve decompression via total tanscanal endoscopic approach. Preoperative evaluation showed that all patients are complete facial paralysis, more than 90% degeneration on electroneurography testing, and absent voluntary electromyography within 14 days of onset. MRI showed abnormal enhancement of the Geniculate ganglion in 4 Bell’s palsy patients and HRCT showed the fracture line of the horizontal segment of the facial nerve or Geniculate ganglion in 5 patients with traumatic facial nerve palsy.

All the patients were followed up to 12th month after surgery. The facial nerve function of all 5 patients with traumatic facial nerve palsy and 2 patients with Bell’s palsy recovered totally (HB-I). The remaining two patients with Bell’s palsy recovered to House-Brackmann II and III at the final follow-up, respectively. After operation, the hearing unchanged in 7 patients including 5 patients with Bell’s palsy and improved in the remaining 2 patients with auditory ossicle dislocation before operation.

In terms of treatment outcomes, total transcanal endoscopic facial nerve decompression is an alternative for lesions limited to the tympanic segment and Geniculate ganglion of facial nerve, and minimally destroyed normal structure and is cosmetically acceptable without an external scar or bony depression due to drilling.