1. Post traumatic complete facial nerve palsy…
is conservative management appropriate?
DR MADAN GUPTA- ENT AIIMS
DR ALOK THAKAR- ENT AIIMS
DR DEEPAK AGRAWAL-NREUROSURGERY AIIMS
DR ATIN KUMAR-RADIODIAGNOSIS AIIMS

2. • The recommened treatment for post traumatic complete
facial nerve paralysis has generally been surgical .
 Farrior and Caldwell - New Orleans Med Sci J.1947;100:23–25
 Tucker and McCabe Laryngoscope. 1978;88:348 –354
 Tuncay Ulug American Journal of Otolaryngology–Head and Neck
Medicine and Surgery 26 (2005) 230– 238
• Some recent realization in the literature that surgical
decompression for such injuries may not be always
indicated. R13.pdf

3. MATERIAL AND METHOD
Single arm Observational study
Cohort of 35 consecutive cases of post- traumatic
complete facial nerve palsy ( H& B grade VI)
secondary to blunt head injury including cases with
demonstrable fractures of the temporal bone.
2010-2012. , AIIMS main hospital and trauma centre
Prospective study

4. Informed consent- discussed treatment options and also of the surgical option.
35 pateints were recurited
7 withdrew from the study
Inclusion criteria
Post traumatic grade VI facial palsy
No response on ENoG
Details of evaluation techniques

5. • Intervention- steroids 1mg kg /body weight/ -21 day
tapering over 15 days and physiotherapy.
• Ongoing observation did by close follow up with EMG.
• Failure of clinical recovery by 4 months or any signs
of nerve degeneration as noted on EMG designated
as indications for surgical treatment.

6. 0
20
40 32
3
0
10
20
30
>20 20-40 40-60
4
21
10
AGE
ONSET
OF
PALSY

7. RESULT-28/35(H & B GRADING)
(2 DENIED FOR ENROLLMENT
5- LOST F/U )
INITIAL EVALUATION
3month
6month
9month
0
5
10
15
20
25
30
GRADE 5,6
GRADE 3,4
GRADE 1,2
28
1
23
4
1
27
1
27

8. INITIAL EVALUATION AFTER 4 MONTH

9. Conclusion
 Longitudinal # remain the most common fracture in post traumatic facial
our experience indicates that surgical
need not be the only recommneded
treatment..
In Post traumatic facial palsy treatment
of choice can be conservative with
close follow up and monitoring with
nerve conduction test.