Associate Professor Barrow Neurological Institute Phoenix, AZ, United States
Disclosure(s):
Shawn M. Stevens, MD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: Surgical decompression of the facial nerve may be indicated when patients present with an acute, complete facial paralysis and poor prognostic indicators for recovery (ENoG, EMG). The procedure is performed most often in cases of traumatic and idiopathic (Bell's) facial palsy and may be a key part of the treatment armamentarium for candidate patients. The goal of the procedure is to maximize the chance for a return of normal/near normal facial function. Due to the complex nature of these clinical presentations, and the oftentimes unstable clinical condition of the patient, this technique may not be routinely encountered during otolaryngology residency training or general practice. Further, a complete facial nerve decompression requires either a translabyrinthine or middle cranial fossa approach to the perigeniculate region - an anatomical area not often visualized by the general otolaryngologist. The goal of this video is to demonstrate, via a dueling-dissection format, relevant anatomy and technique from the perspective of both the middle cranial fossa/transmastoid exposure and translabyrinthine exposure. Relevant anatomy will be compared from two associated perspectives with side-by-side operative videos, and supplemented through the use of augmented intraoperative still imagery. A review of indications, workup, and other clinical considerations will accompany the surgical videos to provide full clinical context. At the conclusion of the presentation, the audience will be able to identify the key elements of diagnostic workup, indications, anatomy, and technique for facial nerve decompression in the treatment of acute facial palsy.
