Facial Paralysis in Skull Base Osteomyelitis – Comparison of Surgical and Nonsurgical Management. (12th May 2022)

• Record Type: Journal Article
• Authors: Freeman, Michael H.; Perkins, Elizabeth L.; Tawfik, Kareem O.; O'Malley, Matthew R.; Labadie, Robert F.; Haynes, David S.; Bennett, Marc L.
• Is Part Of: Laryngoscope. Volume 133:Number 1(2023)
• Page Start: 179
• Page End: 183
• Publication Date: 2022-05-12
• Subjects: facial nerve decompression -- facial palsy -- malignant otitis externa -- skull base osteomyelitis -- surgical outcomes; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.30161
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Title: Facial Paralysis in Skull Base Osteomyelitis – Comparison of Surgical and Nonsurgical Management. Objective: To compare outcomes of surgical and nonsurgical management in cases of facial paresis secondary to skull base osteomyelitis. Methods: A 14 patients presenting with skull base osteomyelitis complicated by facial nerve paresis at a single tertiary referral center from 2009 to 2019 were retrospectively reviewed. Patients were treated with medical therapy with or without surgical intervention, consisting of mastoidectomy and debridement with or without facial nerve decompression. House‐Brackmann (HB) Grade was the main outcome measure. Results: A 14 patients (average age 68 years, range 58–82 years, 71% male) were analyzed, with 5 undergoing facial nerve decompression (36%), 5 undergoing mastoidectomy without facial nerve decompression (36%), and 4 undergoing medical management alone (28%). Of the 4 patients who underwent medical therapy alone, none experienced significant improvement in facial function. Of the 5 patients who underwent facial nerve decompression, 3 patients experienced improved facial function. Of the 5 patients who underwent mastoidectomy without decompression, 4 experienced improved facial function. There was no clear link between the severity of infection and the severity of facial paresis. When comparing HB score changes before and after treatment across groups, there was no statistically significant difference seen ( p = 0.47). Conclusions: Mastoidectomy and debridement with or without facial nerve decompression may improve facial nerve outcomes when compared to isolated medical management, although differences were not of statistical significance. The best facial nerve recoveries occurred in patients undergoing surgery within 14 days of the onset of paralysis. Level of Evidence: 4 – Case Series Laryngoscope, 133:179–183, 2023 Abstract : A 14 patients with facial palsy secondary to skull base osteomyelitis who underwent surgical or nonsurgical management were studied. Mastoidectomy and debridement with or without facial nerve decompression may improve facial nerve outcomes when compared to isolated medical management, although differences were not of statistical significance. The best overall facial nerve recoveries occurred in patients undergoing surgery within 14 days of the onset of paralysis.