PURPOSE OF REVIEW This systematic review investigates the recent literature and aims to determine the approach, efficacy, and timing of facial nerve decompression with or without grafting in temporal bone fractures with facial palsy. RECENT FINDINGS The surgical management of facial palsy is reserved for a small population of cases in which electrophysiologic tests indicate a poor likelihood of spontaneous recovery. The transmastoid (TM), middle cranial fossa (MCF), and translabyrinthine (TL) approaches to the facial nerve provide access to the entire intracranial and intratemporal segments of the facial nerve. In temporal bone (TB) related facial palsy, the peri-geniculate and labyrinthine portions of the facial nerve are most commonly affected by either direct trauma and/or subsequent edema. When hearing is still serviceable, the combined TM/MCF approach provides the best access to these regions. In the presence of severe sensorineural hearing loss (SNHL), the TL approach is the most appropriate for total facial nerve exploration (this can be done in conjunction with simultaneous cochlear implantation if the cochlear nerve has not been avulsed). Grade I to III House-Brackmann (HB) results can be anticipated in timely decompression of facial nerve injury caused by edema or intraneuronal hemorrhage. Grade III outcomes, with slight weakness and synkinesis, is the outcome to be expected from the use of interpositional grafts or primary neurorrhaphy. In addition to good eye care and the use of systemic steroids (if not contraindicated in the acute trauma setting), surgical decompression with or without grafting/neurorrhaphy may be offered to patients with appropriate electrophysiologic testing, physical examination findings, and radiologic localization of injury. SUMMARY Surgery of the facial nerve remains an option for select patients. Here, we discuss the indications and results of treatment as well as the best surgical approach to facial nerve determined based on patient's hearing status and radiologic data. Controversy remains about whether timing of surgery (e.g., immediate vs. delayed intervention) impacts outcomes. However, no one with facial palsy due to a temporal bone fracture should be left with a complete facial paralysis.

中文翻译：

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颞骨骨折相关的面瘫：有和没有移植的减压效果。


综述目的本系统综述调查了最近的文献，旨在确定面神经减压术（有或没有移植）治疗面瘫颞骨骨折的方法、疗效和时机。最近的发现 面部麻痹的手术治疗只适用于少数电生理测试表明自然恢复可能性很小的病例。面神经的经乳突 (TM)、中颅窝 (MCF) 和经迷路 (TL) 入路可到达面神经的整个颅内和颞内段。在颞骨 (TB) 相关的面瘫中，面神经的膝状体周围和迷路部分最常受到直接创伤和/或随后的水肿的影响。当听力仍然可用时，TM/MCF 组合方法可提供进入这些区域的最佳途径。在存在严重感音神经性听力损失 (SNHL) 的情况下，TL 入路最适合全面神经探查（如果耳蜗神经尚未撕脱，则可以与同步耳蜗植入一起进行）。及时对水肿或神经元内出血引起的面神经损伤进行减压，可预期获得I至III级House-Brackmann（HB）结果。 III 级结果，具有轻微无力和联带作用，是使用插入移植物或初次神经缝合术的预期结果。除了良好的眼部护理和使用全身性类固醇（如果在急性创伤情况下没有禁忌）外，还可以为患者提供手术减压（有或没有移植/神经缝合术），并进行适当的电生理测试、体检结果和损伤的放射学定位。 。 摘要 面神经手术仍然是特定患者的一种选择。在这里，我们讨论治疗的适应症和结果，以及根据患者的听力状态和放射学数据确定的最佳面神经手术方法。关于手术时机（例如立即干预还是延迟干预）是否影响结果仍存在争议。然而，因颞骨骨折而导致面瘫的人不应留下完全面瘫。