More Research Needed into Management of Facial Paralysis from Intratemporal Blunt Trauma

What is the management and outcome of facial paralysis from intratemporal blunt trauma?

Background: Many temporal bone fractures, most commonly from motor vehicle accidents, are complicated by facial nerve dysfunction. Frequently, the initial diagnosis of facial nerve injury is delayed due to the altered mental status of the patient and the attention diverted to life-threatening injuries. Multiple factors, such as the onset of nerve dysfunction and test results, can determine management.

Study design: Literature review.

Setting: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin and Affiliated Hospitals, Milwaukee, Wisconsin.

Synopsis: A systematic literature review identified 35 relevant articles in PubMed, with the majority of articles reporting paresis secondary to a temporal bone fracture. All studies were classified as level four evidence as defined by the Oxford Centre for Evidence-Based Medicine. Marked variation in the quality of the studies, with inconsistent outcome measures, diagnostic testing and follow-up, ruled out a formal meta-analysis. The authors said their review highlights the numerous inconsistencies in reporting and the subsequent difficulty in interpreting data. They said correlations between outcomes and radiographic findings, surgical approach, topognostic testing or electrodiagnostic testing could not be made. A total of 612 cases of facial weakness in 606 patients were available for analysis, with outcome variables including severity of paralysis, time of onset of paralysis, surgical or nonsurgical management, steroid use and final facial nerve function. The patients were grouped into categories of those followed observationally (used as the standard to compare other treatment outcomes), those treated with steroids and those who received surgery. Overall, the authors said the papers were so varied in outcome measures and depth of reporting that the data set was too heterogeneous and incomplete to warrant meaningful analysis. However, the team did assign a grade of C (on a scale of A to D) for the overall strength of evidence regarding surgical facial nerve decompression in the setting of intratemporal blunt trauma. The role of steroids was called “unclear,” with the possibility that some patients were administered corticosteroids that were not reported.

Bottom line: The role of surgical versus nonsurgical intervention, as well as the prognostic capability of electrodiagnostic testing and radiographic studies, remain inconclusive. Further investigations with standardized reporting and comparison cohorts are needed.

Citation: Nash JJ, Friedland DR, Boorsma KJ, et al. Management and outcomes of facial paralysis from intratemporal blunt trauma: a systematic review. Laryngoscope. 2010;120(7):1397-1404.

—Reviewed by Sue Pondrom