Transcanal facial nerve decompression under local anaesthesia report of
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otorhinolaryngology
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Transcanal facial nerve decompression under local anaesthesia report of
- 1. TRANSCANAL FACIAL NERVE DECOMPRESSION UNDER LOCAL ANAESTHESIA-REPORT OF 2 CASES Presentor Dr.R.Ram Shankar.MS.ENT
- 2. • Temporal bone fractures are extremely common with head injuries. • They present with hearing loss facial nerve paralysis,vertigo leakage of CSF through the nose and ear. • The temporal bone fractures are longitudinal,transverse or mixed.80% of temporal bone fractures are longitudinal. • Transverse fractures have more risk of permanent facial nerve palsy than longitudinal fractures
- 3. Ketter et al states that inmmediate paralysis should be explored as soon as the patient condition permits because the palsy may be due to 1.Incomplete or complete transaction of nerve 2.Bony fragments compressing the nerve 3.Edema of the nerve due to generalized inflammation due to trauma 4.Compression due to bands formed in the nerve sheath which is caught between the fractured fragments.
- 4. CASE DISCUSSION • 2 patients had head trauma with temporal bone fractures with presented with unilateral facial nerve palsy. • Immediately ENoG was done which revealed 100% degeneration. • Both of them underwent endoscopic transcanal facial nerve decompression under local anaesthesia. • Fractured fragments removed from the horizontal segments of facial nerve and decompression of horizontal segment was done. • Both patients are under followup and the results of nerve exitability test and ENoG in preoperative and postoperative period are recorded.
- 5. • Electroneuronography-100%degeneration • Nerve Excitability Test-Stimulation at 10 mA
- 8. FOLLOW UP…. • Nerve Excitability Test-stimulatied at 10mA
- 9. Traumatic Facial Nerve Paralysis • Temporal bone fractures are classified as either longitudinal(along the long axis of the petrous pyramid), transverse(at right angles to the petrous pyramid), mixed/complex/oblique • Trauma to the temporal and parietal regions of the skull tends to produce longitudinalfractures, which make up the majority (90%) of temporalbone fractures. These fractures cause conductive hearing loss by traversing the tympanic membrane andthe tympanic cavity and by causing a hemotympanum. • Facial paralysis occurs in 20 to 25% of longitudinal fractures, usually in the perigeniculate region.
- 10. • Transverse fractures, whichmake up less than 10% of temporal bone fractures.Transverse fractures manifest with sensorineural hearing loss and vestibular dysfunction owing to involvement of the otic capsule or the IAC. • They are more likely to cause facial nerve paralysis in 50% patients.
- 11. Indication of Facial Nerve Decompression • If the patient either progresses to complete paralysis or presents with complete paralysis, an ENOG is obtained 4 days after occurrence of complete paralysis. If degeneration is less than 90%, the corticosteroids are continued for the full treatment course. Electroneurographic testing is repeated every 1 to 3 days until > 90% degeneration is detected and no voluntary motor unit surgical decompression is indicated.
- 12. Approaches… The facial nerve decompression can be carried out by middle cranial fossa approach, trans labrynthine approach,transmastoid extralabrynthine subtemporal approach or combination of above approaches.
- 13. Conclusion In these patients we highlight the transcanal approach to facial nerve decompression under local anaesthesia and outcome of this procedure.
- 14. Thank You