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 Pitie-Salpetriere 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.