A Clinical Analysis of Facial Nerve Paralysis due to Inflammatory Diseases of the Middle Ear and the Role of Early Decompression
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 8
Abstract
Background: Facial nerve (FN) paralysis is one of the most common intratemporal complications of inflammatory diseases of the middle ear. The pathology of FN paralysis in inflammatory diseases of the middle ear is an erosion of the Fallopius canal is either by erosion by suppuration and its pressure effects, cholesteatoma/granulation tissue or osteonecrosis or osteolysis. Surgical decompression remains the choice of treatment. Aim of the Study: The aim of the study was to analyze the different types of the pathology of FN paralysis in inflammatory diseases of the middle ear intraoperatively and to study the results of FN decompression in a series of patients. Materials and Methods: A total of 52 patients with inflammatory diseases of the middle ear with facial paralysis attending the Department of ENT of Gandhi Medical College Hospital, Secunderabad, Telangana, were included in the study. A thorough ENT examination was done to know the type of inflammatory disease of the middle ear in all the patients. Patients were subjected to topographic diagnosis. Facial weakness was classified according to House–Brackmann’s classification. FN decompression under general anesthesia with canal wall down mastoidectomy was undertaken. Site of the lesion, type of pathology, and post-operative recovery grading were done. Observations and Results: There were 52 patients with facial paralysis in this study; 39 males and 13 female a ratio of 1.3:1. The mean age was 34.65 ± 6.25 years. The incidence was 19/52 (36.53%) in 40–50 years and 19/52 in 20–30 age group. The lesion was at Genu in 6/52 (11.53%) of patients, at tympanic segment in 15/52 (28.84%), vertical segment in 30/52 (57.69%), and Stylomastoid foramen level in 1/52 (01.92%) patients. Cholesteatoma was cause in 13/52 (25%) patients, granulation tissue in 7/52 (13.46%), dehiscence in 3/52 (05.76%) patients, osteitis in 4/52 (07.69%) patients, edema in 11/52 (21.15%) patients, external compression in 9/52 (17.30%), and inflammation of the nerve in 5//52 (09.61%) patients. Following decompression FN palsy of 4 weeks duration, the recovery was in 49/52 (94.23%) patients. Conclusions: Early topographic diagnosis of FN paralysis timely decompression of the nerve exposing it from genu to the stylomastoid foramen results in total recovery of the facial muscle power in >94% of the patients. The pathology causing the paralysis and the site of lesion play an important role in the management as well as its prognosis. Paralysis of longer duration has poor prognosis.
Authors and Affiliations
D. Ranganath Swamy, P. Benjamin Rajendra Kumar
Keywords
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