I. Surgical Approach
In Bell's palsy, topognostic examination often revealed a suprastapedial lesion. In such cases, decompression from the geniculate ganglion to the stylomastoid foramen was considered to be a rational treatment. The operation included the following procedures: 1) a transcortical mastoidectomy, 2) a hypotympanotomy, 3) removal of the incus, 4) exposure of the entire horizontal segment of the facial nerve below the geniculate ganglion, 5) exposure of the pyramidal and vertical segments, 6) incision of the nerve sheath, and 1) replacement of the incus. Thus sufficient decompression could be made on the facial nerve from the geniculate ganglion to the stylomastoid foramen. When the incus was replaced exactly in the original position, there remained no permanent hearing impairment.
II. Indication and Results
Decompression from the geniculate ganglion to the stylomastoid foramen was carried out on 51 patients with Bell's palsy. The operational results were compared with those of 77 patients in whom the pyramidal and vertical segments were decompressed. Regardless of the operational timing, a more satisfactory surgical result was obtained in the former group of the patients. In either group, decompression in the acute phase, within 30 days after the onset, ensured a most desirable effect and in the surgery performed in the subacute phase, between 31 and 90 days after the onset, a favourable effect could be obtained. Advantageous effect of the surgery done during the chronic phase, that is beyond 91 days after the onset, could not be confirmed.
III. Findings of the Operation
Decompression from the geniculate ganglion to the stylomastoid foramen was made on 51 patients with Bell's palsy. Edema of the nerve was observed in 88% of all patients. In 49%, the edema was located between the geniculate ganglion and the pyramidal segment, while in 39%, the edema was limited in the vertical segment. Thickness of the nerve sheath was noted in the 48%. A defect of the facial canal was noted in the 42%. The incidence of this bony defect was significantly higher than that found in cases of chronic otitis media. On the basis of these findings, it is concluded that a decompression of the facial nerve up to the geniculate ganglion is reasonable in the majority of patients with Bell's palsy.
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