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170 - Intratemporal facial nerve surgery
Book chapter

170 - Intratemporal facial nerve surgery

Rick F. Nelson, Jay A Gantz and Bruce J. Gantz
Cummings Otolaryngology, pp.2607-2620.e1
Elsevier Health, Eighth Edition
2026
DOI: 10.1016/B978-0-443-11984-2.00179-1

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Abstract

Objectives: To discuss the surgical approaches to the facial nerve, including the technical nuances, surgical anatomy, and the advantages and disadvantages of each. Design: Review of the literature and author expertise are highlighted to discuss the retrosigmoid, retrolabyrinthine, middle fossa, translabyrinthine, and combined approaches to the facial nerve. Results: The retrosigmoid and retrolabyrinthine approaches provide access to the brainstem and cisternal segments of the facial nerve. The middle fossa approach allows decompression of the labyrinthine and tympanic segments with hearing preservation, whereas the translabyrinthine approach allows access to the entire intratemporal facial nerve but does not preserve hearing. For patients with severe Bell’s palsy, with more than 90% degeneration on electroneuronography and no voluntary motor unit potentials, the middle cranial fossa approach for decompression within 2 weeks of onset results in high rates of facial nerve recovery to House-Brackmann grade I or II function as compared with steroids alone (92% vs. 42%). Conclusions: Appropriate management of facial nerve disorders requires a thorough knowledge of the pathophysiology of diseases that affect the facial nerve, experience in the interpretation of findings on radiologic and electrophysiologic tests of the nerve, and expertise in multiple neurotologic surgical approaches to the facial nerve.
 Bell’s palsy degeneration Facial nerve facial nerve tumor middle fossa neurorrhaphy

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