UI-led study indicates surgery is the best treatment for severe Bell's palsy paralysis

ed that electrical testing was the best method to differentiate a patient with Bell's palsy who has an excellent prognosis from an individual who might have a poor return of facial movement. The testing relies on the use of two strategies. The first, called electroneurography (ENOG), involves stimulating facial nerves and recording their potential to trigger facial movement. Patients with less than 90 percent degeneration in the first two weeks as measured by ENOG recover normal or near-normal facial function. Patients whose tests reveal have higher than 90 percent degeneration subsequently receive electromyography (EMG) testing, which involves inserting a needle electrode in the face and measuring a patient's ability to make forceful contractions. If the patient fails to demonstrate voluntary motor function using EMG, the patient likely has only a 42 percent chance of normal or near-normal recovery. However, if individuals within this subgroup opt for surgical decompression of the facial nerve within two weeks of the onset of paralysis, they increase their chances of recovery to 91 percent.

To perform the decompression procedure, a surgeon first makes a bone "window" by removing a piece of the skull on the side of the head. The region where the facial nerve is tightly encased with bone is exposed using microscopic dissection and a micro-drill. Relieving the constricted portion of the nerve allows earlier recovery and improved outcome.

"Many physicians don't think surgical management is worthwhile because of past controversial results and because it is a very technically demanding procedure," Gantz said. "But we demonstrated that electrical testing can identify a small subgroup that will have residual facial dysfunction, and surgical decompression eliminated poor outcomes in more than 90 percent of this group."

Risks involved in the procedure are minimal, Gantz said. There is less than a 1 percent chance of hearing loss and a 4 to 5 percent chance of te

Contact: Jennifer Cronin
University of Iowa

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