[Diagnostic and treatment of lesions of the facial nerve after fractures of the temporal bone].

The authors review functional late results of 47 cases of facial palsies due to otobasal fracture by considering the clinical and electrophysiological test results, seen between 1983 and 1988. There were 36 longitudinal, 5 transversal and 6 combined temporal bone fractures. 5 patients suffered from a bilateral facial paralysis. In all cases, an electrodiagnostic examination was carried out in order to determine the pronosis and to indicate a surgical exploration. The electrodiagnostic consisted in electromyographie (EMG) and electroneuromyographie (ENoG). 36 patients got a medical treatment and 6 patients were treated by surgery. All facial nerve paralyses (n = 28), that were incomplete according to the clinical examination as well as the electrophysiological tests, received a medical treatment which lead to good functional late results without exception. 19 facial nerve paralyses seemed to be complete in clinical examination, but in 11 cases electrodiagnostic tests revealed a residual volontary electrical activity. This indicated a conservative therapy with 7 good (66%) and 4 (33%) fair results. So, no poor result had been found in this group. In the other 8 cases, 4 of which had a delayed onset of the paralysis, no electrocal activity could be proved. 4 patients were treated by surgery, and in 2 cases a complete facial nerve transection was found. The reconstruction of the facial nerve led to 1 good and to 1 satisfactory result. In the other 2 cases, the decompression lead to 1 good and to 1 poor late result. In these 4 cases the facial nerve had been completely decompressed, in a combined transmastoidal and enlarged transtemporal middle fossa approach.(ABSTRACT TRUNCATED AT 250 WORDS)