Epidemiology of Facial Nerve Palsy in Temporal Bone Fractures and It’s Treatment Outcome: A Prospective Longitudinal Study from Central Kerala

Abstract

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.