Surgical treatment of the facial nerve in facial paralysis

The primary indication for facial nerve surgery is facial nerve paralysis. Most commonly, the cause of the paralysis is inflammation owing to idiopathic or infectious conditions. Primary or secondary facial nerve tumor and trauma follow. Inflammation of the nerve leads to the cycle of entrapment, ischemia, and degeneration. The most common surgical procedure for facial nerve paralysis is facial nerve decompression. Decompression of the intratemporal facial nerve is performed in selected cases of Bell's palsy, by far the most common inflammatory etiology of facial nerve paralysis, followed less frequently by acute and chronic otitis media. The middle fossa craniotomy approach is the only procedure that allows meatal facial nerve decompression and hearing preservation in all cases. Traumatic facial nerve paralysis may require facial nerve exploration, decompression, and/or repair. In neurotology, the most common reason for traumatic paralysis is temporal bone fracture, either as a result of blunt or penetrating injury. The management of the facial paralysis in primary or secondary tumors of the facial nerve is dictated by tumor histology and extent.