Abstract
Facial nerve injury is a severely disfiguring complication of temporal bone fractures. We retrospectively reviewed the records of 768 patients diagnosed with basilar skull fractures in various emergency hospitals including our hospital. Of these, 282 patients had temporal bone fractures. Forty-one out of the 282 patients (14.5%) had facial nerve palsy: 7 patients with immediate facial palsy, 33 with delayed-onset facial palsy (DFP), and one with delayed-onset dysgeusia but without facial motor palsy. The onset date of DFP was defined as the day when a doctor noticed the appearance of facial palsy on the daily round. Of the 33 DFP patients, 25 (75.8%) were men. They ranged in age from 7 to 84 years (39.7±20.6 years). The median onset time of DFP was day 6. Facial nerve dysfunctions were classified by the House-Brackmann (HB) facial grading system. The patients were managed conservatively with steroids and facial rehabilitation in principle. We periodically monitored the improvement of facial palsy. In this study we judged the patients had recovered from facial nerve palsy when the HB grade of facial never function was improved to II. After we excluded patients who underwent facial nerve decompressive surgery (n＝1) and had only mild DFP less than grade III (n＝3), the remaining 29 (DFP) patients were enrolled for subsequent follow-up analysis (7＝HB grade III, 15＝HB grade IV, 7＝HB grade V, and 0＝HB grade VI). Twenty seven patients (93.1%) recovered within one year, but two severe DFP patients did not show a valid recovery. A log-rank test showed that there was a statistical difference in recovery period between moderate (HB grade III and IV) and severe facial palsy groups (HB grade V) (p＝0.024). The median period for recovery was 50 days in the moderate group and 93 days in the severe group. Although 28.6% (2/7 patients) of severe DFP did not achieve the recovery with the conservative management alone, we conclude that nonsurgical treatment is strongly recommended for patients with moderate DFP.
