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Management of the facial nerve in cholesteatoma surgery: Multidisciplinary approach in a Facial Paralysis Unit

Presenting Author: Luis Lassaletta

Published online by Cambridge University Press:  03 June 2016

Luis Lassaletta ,
Julio Peñarrocha ,
Teresa Gonzalez ,
Susana Moraleda  and
Javier Gavilan
Luis Lassaletta
Affiliation:
La Paz University Hospital
Julio Peñarrocha
Affiliation:
La Paz University Hospital
Teresa Gonzalez
Affiliation:
La Paz University Hospital
Susana Moraleda
Affiliation:
La Paz University Hospital
Javier Gavilan
Affiliation:
La Paz University Hospital
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Abstract

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Learning Objectives: Upon completion of this presentation, the attendant should be able to: Learn the main aspects to consider when dealing with a facial nerve surrounded or invaded by cholesteatoma Have a general idea about facial nerve reconstruction depending the status of the nerve, the time of evolution and patient's preferences.

Introduction: The incidence of facial paralysis in patients with middle ear cholesteatoma is generally low but still present in 2016. Particular situations such as petrous bone cholesteatoma, in which facial nerve involvement is reported to be as high as 45% to 65% of cases, or revision cases may lead to facial nerve problems more frequently.

In most cases, prompt nerve decompression is enough to achieve recovery. However, facial nerve reconstruction may be needed in certain patients.

Regarding the management of the facial nerve in temporal bone surgery, some aspects are still controversial:

  1. 1. Should we use intraoperative facial nerve monitoring in a routine basis?

  2. 2. How should the compressed nerve be managed intraoperatively?

  3. 3. What is the best reinnervation technique for a particular situation?

Methods: A series of cholesteatoma cases with difficult management of the facial nerve will be presented in a step-by-step manner. Pictures and videos with the key aspects will be shown.

Results: Different surgical techniques including nerve decompression, nerve grafting, and reinnervation procedures were included. Eye care including eyelid surgical procedures, as well as botox injection and neuromuscular retraining were also needed for some patients. All the patients improved facial function following different therapeutic options.

Conclusions: Facial paralysis is still a possible complication of cholesteatoma and chronic ear surgery. Early management with the appropriate technique is mandatory. The preoperative facial nerve grade, the duration of symptoms, and the intraoperative findings, including the location and type of facial nerve injury are the main factors to consider. A multidisciplinary approach in a Facial Paralysis Unit is the key to achieve the best results for a particular patient.