Decompression Surgery for Facial Nerve Paralysis

NYU Langone neurotologists, surgeons who specialize in nerves that affect the head and neck, are among the few specialists in New York City who perform a surgery called middle fossa facial nerve decompression for facial nerve paralysis. In this procedure, doctors enlarge the space through which the seventh cranial nerve travels.

If decompression surgery is performed within two weeks of the onset of symptoms—preferably within days—doctors can relieve pressure on the nerve, possibly preventing permanent nerve damage and accelerating your recovery.

Surgeons determine if a decompression procedure is required using a diagnostic test called electroneurography. This test measures muscle response to nerve stimulation. The results help doctors determine whether a nerve is able to regenerate, eventually returning motion to the facial muscles.

Working with an audiologist, your doctor performs electroneurography at the time of diagnosis. The test is often repeated two days later to determine if nerve activity has improved. If it has, your doctor waits and tests the nerve again in two days. If activity continues to increase, the nerve is recovering and a person can regain control of facial muscles without surgical intervention. Complete recovery may take three to six months. The amount of control a person has over the facial muscles improves slowly.

If there is no nerve activity or it has not improved—and if the paralyzed nerve has less than 10 percent of the amount of nerve activity on the healthy side of the face—a doctor may consider decompression surgery to help the nerve recover.

Decompression is a complicated procedure. It involves removing the bone that is constricting the seventh cranial nerve. This is challenging because the nerve follows a meandering path from the brain stem to the face. It travels through the temporal bone around the inner ear structures.

To perform the procedure, surgeons approach the nerve from above the ear through the skull. Surgeons use general anesthesia, and most people remain in the hospital for two days after surgery for observation.

What to Expect After Surgery

After decompression surgery, the nerve may take a long time to recover. Eye protection is important until nerve recovery and eyelid closure occurs. People can resume most activities within two weeks of surgery.

Ten days after surgery, the sutures are removed. Follow-up visits occur in intervals of two months so your doctor can monitor your recovery.

Physical therapists at NYU Langone’s Rusk Rehabilitation specialize in facial nerve rehabilitation. Therapy helps you regain control over your facial muscles in a way that looks natural.

For many people, decompression surgery increases the chance of recovery from facial nerve paralysis from about 20 percent to more than 85 percent.

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