Epidemiology of Facial Nerve Palsy in Temporal Bone Fractures and It’s Treatment Outcome: A Prospective Longitudinal Study from Central Kerala
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As the majority of temporal bone fractures are associated with concurrent intracranial and cervicospinal injuries, facial nerve examination is given least importance. But it affects the quality of life in all aspects. A prospective longitudinal study was conducted in 61 consecutive patients with temporal bone fractures admitted in a time period of 18 months.
Detailed analysis including mode of injury,otoscopic examination,clinical examination of facial nerve by House Brackmann grading, topodiagnostic test ,electrodiagnostic tests ,audiological tests and radiological evaluation and mode of intervention were done. Patients were followed up in a three monthly basis for a period of one year or earlier until complete recovery. Road traffic accidents(80.3%) were the most common mode of injury The incidence of facial nerve palsy in temporal bone fractures in our study was 14.75%. All the patients with facial nerve palsy were given conservative medical management which included oral steroids on a tapering regime, eye care and facial physiotherapy. Immediate onset higher grade facial palsy with no clinical improvement and electroneuronogram showing less than 5 % response , supported by radiological evidence were taken up for surgical intervention. In this study,85.7% of patients who were managed conservatively had recovery. Even though there was improvement in clinical outcome , none of the patients who underwent surgical management recovered fully. The timely diagnosis and management of facial nerve palsy improves the post traumatic quality of life. So a team work of otolaryngologists, neurosurgeons, radiologists, ophthalmologists and physiotherapists are needed for the efficient management of facial nerve palsy.
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Brodie HA, Thompson TC.Management of complications from 820 temporal bone fractures .Am J Otol.1997 Mar; 18(2):188-97.
Sun GH, Shoman NM, Samy RN, Cornelius RS, Koch BL, Pensak ML. Do contemporary temporal bone fracture classification systems reflect concurrent intracranial and cervical spine injuries?. Laryngoscope. 2011 May. 121(5):929-32.
Chan JY, Byrne PJ. Management of facial paralysis in the 21st century. Facial Plast Surg. 2011 Aug;27(4):346-57
Aggarwal SK, Gupta AK, Modi M, Gupta R, Marwaha N. Safety Profile of Bone Marrow Mononuclear Stem Cells in the Rehabilitation of Patients with Posttraumatic Facial Nerve Paralysis—A Novel Modality (Phase One Trial). Journal of Neurological Surgery Part B, Skull Base. 2012;73(4):245-52.
Ringl H, Schernthaner RE, Schueller G, Balassy C, Kienzl D, Botosaneanu A, et al. The skull unfolded: a cranial CT visualisation algorithm for fast and easy detection of skull fractures. Radiology 2005; 255(2):553-62
Zayas FO, Feliciano YZ, Hadley CR, Gomez AA, Vidal FA. Temporal bone trauma and the role of multidetector CT in the emergency department. Radiographics 2011; 31(6):1741-55
Aguilar E A ,Yeakley J W., Ghorayeb BY., Hauser M, Cabrera J, Jahrsdoerfer R. A.. High resolution CT scan of temporal bone fractures: association of facial nerve paralysis with temporal bone fractures. Head Neck Surg. 1987;9:162–6.
Exadaktylos AK, Sclabas GM, Nuyens M, et al. The clinical correlation of temporal bone fractures and spiral computed tomographic scan: a prospective and consecutive study at a level I trauma center. J Trauma 2003;55(4):704–706
Fu L, Bundy C, Sadiq SA. Psychological distress in people with disfigurement from facial palsy. Eye. 2011;25(10):1322-26.
Fonseca KM, Mourão AM, Motta AR, Vicente LC. Scales of degree of facial paralysis: analysis of agreement. Braz J Otorhinolaryngol. 2015 May-Jun;81(3):288-93
Kumar R, Mittal RS. Post Traumatic Delayed Bilateral Facial Nerve Palsy (FNP): Diagnostic Dilemma of Expressionless Face. Journal of Clinical and Diagnostic Research : JCDR. 2015 Apr;9(4):PD15-PD16
World Health Organisation-Global Health Observatory data- Road Safety.available from: http://www.who.int/gho/road_safety/en/
Kerala police .Road Accidents in kerala - Official website of Kerala Police.[internet] 2015; available from: http://keralapolice.gov.in/newsite/road.html
Amin Z, Sayuti R, Kahairi A, Islah W, Ahmad R. Head injury with temporal bone fracture: one year review of case incidence, causes, clinical features and outcome. Med J Malaysia. 2008 Dec;63(5):373-6.
Yetiser S, Hidir Y, Gonul E.Facial nerve problems and hearing loss in patients with temporal bone fractures: demographic data. J Trauma. 2008 Dec;65(6):1314-20.
Patel A,Groppo E. Management of Temporal Bone Trauma. Craniomaxillofac Trauma Reconstr. 2010 Jun; 3(2): 105–13.
Coker NJ, Kendall KA, Jenkins HA, Alford BR Traumatic intratemporal facial nerve injury: management rationale for preservation of function. Otolaryngol Head Neck Surg. 1987 Sep;97(3):262-9.
Lee H, LumC, Means K, Chandrasekhar S, Brown L, Holodny A. Temporal bone fractures and complications: Correlation between high-resolution computed tomography and audiography .Emerg Radiol. 1998 Jan:5(1):8-12.
Aslan H, Songu M, Eren E, Başoğlu MS, Özkul Y, Ateş D, Katilmiş H, Güvenç G. Results of decompression with middle cranial fossa approach or traumatic intratemporal facial nerve injury. J Craniofac Surg. 2014 Jul;25(4):1305-8
Cvorovic L, Jovanovic MB, Markovic M, Milutinovic Z, Strbac M.Management of complication from temporal bone fractures.Eur Arch Otorhinolaryngol. 2012 Feb;269(2):399-403.
Gupta N, Varshney S, Bist SS, Bhatia R. A study of temporal bone fractures. Indian Journal of Otolaryngology and Head & Neck Surgery. 2008;60(3):223-6.
Liu-Shindo M, Hawkins DB. Basilar skull fractures in children. Int J Pediatr Otorhinolaryngol 1989;17(2):109–117.
Turel Keki E, Sharma NK, Verghese Joy, Desai Sanjeev. Posttraumatic facial palsy: Treatment options and strategies. Ind J Neurotrauma 2005;2(1):33-4.
Chang CYJ, Cass SP. Management of facial nerve injury due to temporal bone trauma. Am J Otol 1999;20(1):96–114
Darrouzet V, Duclos JY, Liguoro D, Truilhe Y, De Bonfils C, Bebear JP. Management of facial paralysis resulting from temporal bone fractures: our experience in 115 cases. Otolarygol Head Neck Surg.2001;125:77–84.
May M. nerve repair. In: May M,Schaitkin BM, editors. The facial nerve. May’s 2nd edition. New York: Thieme; 2000. p.571-609
Kamerer DB, Thompson SW. Middle ear and temporal bone trauma. In: Bailey BJ, ed. Head and Neck Surgery— Otolaryngology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001
Hato N, Nota J, Hakuba N, Gyo K, Yanagihara N.Facial nerve decompression surgery in patients with temporal bone trauma: analysis of 66 cases. J Trauma.2011Dec;71(6):1789-93
Kulkarni AS, Karnik P,Nataraj U.Post traumatic immediate onset facial palsy-delayed exploration with complete recovery. Int J Head Neck Surg 2013;4(3):148-51
