Vol. 10, No 3, 2003 pp. 145 - 147
UC 616.833.17-009.11
TRAUMATIC FACIAL PALSY
Dragoljub Popović, Milan Stanković, Zorica Popović, Dušan Milisavljević
Clinic of Otorhinolaryngology, Faculty of Medicine, Niš, Serbia
Summary. Facial nerve palsy may represent an important complication
of head trauma; yet, an adequate surgical treatment can reduce negative
effects of such injuries. The surgical treatment usually consists of nerve
decompression, nerve anastomosis and graft technique with n. auricularis
magnus. In this study a retrospective analysis of the patients treated
from the traumatic facial palsy in a ten-year period was performed. The
patients were divided into groups according to etiology and intensity of
facial damage. Clinical examination, topodiagnostics, electrodiagnostics
and radiography were applied as routine. The House Brackmann scale was
used for evaluation of results of medicaments and surgical therapy.
The traumatic facial palsy was mainly incomplete (62.9%) with other
frequent otologic symptoms. The temporal bone fracture was verified in
88.6% of patients and an intraoperative lesion of the nerve was predominantly
suprastapedial (69.2%). Edema of nerve and fracture line were usually found.
Different surgical techniques were applied (decompression in 84%, termino-terminal
anastomosis in 9% and nerve graft in 7% of cases). The recovery of the
facial function was good and fast in idiopathic cases with a significant
difference between complete and incomplete palsy. In surgical cases, the
best recovery was achieved with decompression while nerve anastomosis and
nerve graft had similar time course and outcome in the House grades.
Conclusion: The surgical therapy in selected cases of peripheral facial
palsy gives good results. The decompression of the nerve is significantly
more effective than nerve anastomosis and nerve graft, concerning both
time and outcome. The type of surgery and the results depend on etiology,
intensity, location and time of treatment of the facial palsy.
Key words: Facial nerve, palsy, trauma, surgery
TRAUMATSKA PARALIZA FACIJALISA
Kratak sadržaj: Paraliza facijalnog nerva može biti značajna komplikacija
traume glave, a pravilan hirurški tretman može umanjiti njihov negativan
efekat. Hirurška terapija se obično sastoji od dekompresije nerva, anastomoze
ili primene transplantata nerva. U ovom radu učinjena je retrospektivna
analiza desetogodišnje terapije traumatskih paraliza facijalisa je sprovedena.
Klinički pregled, topodijagnostika, elektrodijagnostika i radiografija
su bile rutinski primenjene kod svih pacijenata. House Brackmann-ova skala
je korišćena za evaluaciju rezultata medikamentne i hirurške terapije.
Traumatska paraliza facijalisa bila je pretežno nekompletna (62,9%)
sa prisutnim drugim otološkim simptomima. Fraktura temporalne kosti verifikovana
je u 88,6% pacijenata, a intraoperativnim nalazom utvrđeno je da je paraliza
uglavnom suprastapedijalna (69,2%). Edem nerva i frakturna linija su često
nađeni. Primenjene su različite hirurške tehnike: dekompresija u 84%, termino-terminalna
anastomoza i transplantat imali sličan ishod.
Zaključak: Hirurška terapija u određenim slučajevima traumatske paralize
facijalnog nerva daje dobre rezultate. Dekompresija nerva daje značajno
bolji uspeh od anastomoze ili transplantata nerva. Tip hirurške terapije
i rezultat je u korekciji sa etiologijom, intenzitetom, mestom i vremenom
tretmana traumatske paralize facijalisa.
Ključne reči: Facijalni nerv, paraliza, trauma, hirurško lečenje
