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<p>Facial nerve palsy secondary to temporal bone pathology results in significant functional and psychosocial morbidity. Precise lesion localization is crucial for selecting the appropriate surgical approach for facial nerve decompression. To assess outcomes of facial nerve decompression using transmastoid and transcanal approaches based on anatomical lesion localization in traumatic and infective facial nerve palsy. This prospective observational study included nine patients with lower motor neuron facial nerve palsy treated at a tertiary care centre between January 2023 and January 2025. All patients underwent clinical evaluation, high-resolution computed tomography of the temporal bone (HRCT-TB), topodiagnostic testing, and audiological assessment. Surgical approach was determined by the involved facial nerve segment. Facial nerve function was graded using the modified House–Brackmann (HB) scale, and hearing outcomes were assessed with pure tone audiometry preoperatively and at six months postoperatively. All patients completed six months of follow-up. Good facial nerve recovery (HB grade I/II) was achieved in eight patients (88.9%), while one patient (11.1%) showed minimal improvement. Mean HB grade improved from 4.22 to 1.44 (mean improvement 2.78 ± 0.83; <i>p</i> &lt; 0.01). Mean air–bone (AB) gap reduced significantly from 33 ± 20.8&#xa0;dB to 11.89 ± 5.0&#xa0;dB (mean improvement 21.1 ± 17.9&#xa0;dB; <i>p</i> &lt; 0.01). Lesion-directed facial nerve decompression provides excellent functional and audiological outcomes. The transcanal approach is suitable for tympanic segment and first genu involvement, whereas the transmastoid approach is preferred for mastoid segment, multisegment involvement or infective pathology.</p>

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Facial Nerve Decompression Guided by Lesion Localization: Role of the Transmastoid and Transcanal Approaches

  • 期刊论文

  • 发表日期：

    2026年4月6日

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  • T. Satish Chandra,
  • Vineesha Kativarapu

摘要

Facial nerve palsy secondary to temporal bone pathology results in significant functional and psychosocial morbidity. Precise lesion localization is crucial for selecting the appropriate surgical approach for facial nerve decompression. To assess outcomes of facial nerve decompression using transmastoid and transcanal approaches based on anatomical lesion localization in traumatic and infective facial nerve palsy. This prospective observational study included nine patients with lower motor neuron facial nerve palsy treated at a tertiary care centre between January 2023 and January 2025. All patients underwent clinical evaluation, high-resolution computed tomography of the temporal bone (HRCT-TB), topodiagnostic testing, and audiological assessment. Surgical approach was determined by the involved facial nerve segment. Facial nerve function was graded using the modified House–Brackmann (HB) scale, and hearing outcomes were assessed with pure tone audiometry preoperatively and at six months postoperatively. All patients completed six months of follow-up. Good facial nerve recovery (HB grade I/II) was achieved in eight patients (88.9%), while one patient (11.1%) showed minimal improvement. Mean HB grade improved from 4.22 to 1.44 (mean improvement 2.78 ± 0.83; p < 0.01). Mean air–bone (AB) gap reduced significantly from 33 ± 20.8 dB to 11.89 ± 5.0 dB (mean improvement 21.1 ± 17.9 dB; p < 0.01). Lesion-directed facial nerve decompression provides excellent functional and audiological outcomes. The transcanal approach is suitable for tympanic segment and first genu involvement, whereas the transmastoid approach is preferred for mastoid segment, multisegment involvement or infective pathology.