Surgical Approaches of Traumatic Facial Nerve Paralysis

Abstract

Background: Traumatic facial nerve paralysis is a serious complication that may occur following accidental trauma, temporal bone fractures, penetrating injuries, or iatrogenic surgical interventions. The degree of facial nerve dysfunction ranges from partial paresis to complete paralysis and may significantly affect both functional and cosmetic outcomes. Surgical management remains challenging because the choice of the operative approach depends on the site and extent of injury, hearing status, and associated temporal bone pathology. Several surgical approaches have been described for facial nerve decompression and repair, including transcanal transtympanic, transmastoid, middle cranial fossa, combined transmastoid-middle cranial fossa, retrolabyrinthine, and translabyrinthine approaches. Early surgical intervention has been associated with improved recovery rates, particularly in patients with severe degeneration demonstrated by electrophysiological studies. Recent studies demonstrated favorable outcomes following decompression surgery, especially when performed within the first weeks after trauma and when guided by radiological and electrophysiological findings. This review discusses the different surgical approaches for traumatic facial nerve paralysis, their indications, operative techniques, advantages, limitations, and reported outcomes in the literature.