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Management and outcomes of facial paralysis from intratemporal blunt trauma: A systematic review

Authors

  • John J. Nash MD,

    1. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin and Affiliated Hospitals, Milwaukee, Wisconsin, U.S.A.
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  • David R. Friedland MD, PhD,

    Corresponding author
    1. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin and Affiliated Hospitals, Milwaukee, Wisconsin, U.S.A.
    • Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226
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  • Keren J. Boorsma BS,

    1. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin and Affiliated Hospitals, Milwaukee, Wisconsin, U.S.A.
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  • John S. Rhee MD, MPH

    1. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin and Affiliated Hospitals, Milwaukee, Wisconsin, U.S.A.
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

  • This paper was presented as a poster at the Triological Combined Sections Meeting, Orlando, FL.

Abstract

Objectives/Hypothesis:

To systematically review the existing literature on outcomes and management of facial paralysis resulting from intratemporal blunt trauma.

Study Design:

Systematic review of the literature.

Methods:

Thirty-five articles met our inclusion criteria. Outcome variables analyzed included severity of paralysis, time of onset of paralysis, surgical or nonsurgical management, steroid use, and final facial nerve function.

Results:

All studies were classified as level 4 evidence as defined by the Oxford Centre for Evidence-Based Medicine. There was marked variation in the quality of the studies with inconsistent outcome measures, diagnostic testing, and follow-up, thus ruling out a formal meta-analysis. In an exploratory pooling of data, 612 cases had sufficient follow-up and facial movement grading for some evaluation of trends. In 189 patients who were followed observationally, 66% achieved an outcome equivalent to House-Brackmann (HB) I, 25% achieving HB II-V, and two patients an HB VI score. Among 83 patients treated with steroids, 67% achieved HB I, 30% HB II-V, and no patients with HB VI. In 340 patients treated surgically, 23% achieved HB I postoperatively, 58% were graded as HB II-V, and 9% with HB grade VI postoperatively. No patient presenting with partial paralysis had an HB VI outcome.

Conclusions:

The role of surgery versus nonsurgical interventions for this clinical entity remains inconclusive. Level 4 evidence studies predominate and are further hindered by poor description of outcome measures and incomplete data reporting. Exploratory pooling of data without formal meta-analysis suggests the need to compare any intervention to the natural course of healing, which overall appears to be favorable. Laryngoscope, 2010

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