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Total Facial Nerve Decompression via Combined Middle Cranial Fossa and Transmastoid approach

Authors:

Gavriel D. Kohlberg, MD – University of Cincinnati

Noga Lipschitz, MD – University of Cincinnati

Charlie Poff, BS – Medical University of South Carolina

Ravi N. Samy, MD, FACS – University of Cincinnati

Total Facial Nerve Decompression via Combined Middle Cranial Fossa and Transmastoid approach
- Temporal bone trauma - Iatrogenic facial nerve injury - Tumor resection - Recurrent Bell's palsy
- Inability to tolerate temporal craniotomy / middle cranial fossa approach
- Patient positioned supine with head turned to the side
- Computed Tomography (CT) scan - Magnetic resonance imaging (MRI) scan - Electroneuronography (ENoG) - Facial Electromyography (EMG)
Middle cranial fossa approach: - A 4cm x 5 cm is created centered on the zygomatic root - The temporal lobe is retracted to expose the middle cranial fossa floor - The greater superficial petrosal nerve (GSPN) is identified - The middle ear space is identified via unroofing of the middle ear space - The tympanic segment of the facial nerve is identified and decompressed by following GSPN posteriorly - The superior semicircular canal is identified - The internal auditory canal is idenified - The labyrinthine segment of the facial nerve is identified and decompressed of bone - The internal auditory canal dura is opened and the facial nerve is evaluated proximally to the brainstem Transmastoid: - The sigmoid sinus is identified - The posterior external auditory canal is identified - The tegmen mastoidium is identified - The digastric muscle is identified - The lateral semicircular canal is identified - The incus is identified - The mastoid segment of the facial nerve is identified and decompressed - The facial recess is identified and opened - The stapes is identified - The incudostapedial joint is identified and separated - The tympanic segment of the facial nerve is identified and decompressed of bone
Advantages: - The surgery allows for total decompression and evaluation of the facial nerve from the brainstem through the mastoid component of the nerve - The surgery allows for hearing preservation (both conductive and sensorineural) by sparing the ossicular chain and the labyrinth (compared to the translabyrinthine approach for example) Disadvantage: - The surgery requires a temporal craniotomy and retraction of the temporal lobe (something that is not required in the translabyrinthine approach)
- Bleeding, pain, infection, cerebrospinal fluid leak, meningitis, facial nerve paralysis or weakness, deafness, dizziness, tinnitus, taste change
Dr. Ravi N. Samy, MD, FACS receives research support from Cochlear Corporation
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