Purpose of review: Facial nerve paralysis is a debilitating condition. Bell's palsy and temporal bone trauma are common causes of acute facial palsy, with recurrent idiopathic paralysis and Melkersson-Rosenthal syndrome accounting for a smaller subset of cases. Properly selected patients may benefit from facial nerve decompression. This article will review the relevant literature on facial nerve decompression.
Recent findings: The middle cranial fossa approach provides access to the primary site of lesion in Bell's palsy while preserving hearing. Patients with complete facial paralysis secondary to Bell's palsy or temporal bone trauma, more than 90% degeneration on electroneurography testing, and absent voluntary electromyography within 14 days of onset may benefit from facial nerve decompression. Facial nerve decompression may prevent future occurrences of recurrent forms of facial nerve paralysis. The return of facial nerve function following decompression will occur over weeks to months.
Summary: Appropriately selected patients with facial paralysis secondary to Bell's palsy or temporal bone trauma may benefit from facial nerve decompression. Patients should be counseled regarding the risks of decompression and that the return of maximal facial nerve function may be delayed up to 12 months.