Surgical Outcomes in Idiopathic Recurrent Facial Nerve Paralysis: A Rare Clinical Entity

Objective: To evaluate the postoperative facial nerve dysfunction, audiometric outcomes, and long-term quality-of-life outcomes of patients with idiopathic recurrent facial nerve paralysis (RFP) after middle cranial fossa (MCF) microsurgical decompression. Methods: Retrospective chart analysis of 11 (mean age 37.0 years, range 5 to 67) patients at an academic tertiary referral center who underwent MCF facial nerve decompression. Data analysis included evaluation of pre- and postoperative House-Brackmann (HB) score, pre- and postoperative pure-tone average (PTA), pre-and postoperative word recognition scores (WRS), and postoperative Facial Clinimetric Evaluation survey. Results: Mean number of preoperative facial paralysis episodes was 3.5 (range 2 to 6), and preoperative HB score was 4.5 (range 1 to 6). Postoperatively, 0 patients had further episodes of facial nerve paralysis at an average of 6.5 years (range 0.1 to 17.6) (P = 0.005), and the average postoperative HB score was 2.1 (range 1 to 3) (P = 0.011). Postoperative audiometry was stably maintained as assessed with PTA and WRS scores. Conclusion: Microsurgical facial nerve decompression for idiopathic RFP may be a reliable therapeutic modality to prophylactically decrease the number of facial nerve paralysis episodes and may also help to improve facial nerve functional status. Level of Evidence: 4 Laryngoscope, 130:200–205, 2020.