Clinical Study of Transcanal Endoscopic Facial Nerve Decompression for Traumatic Facial Paralysis Refractory to Conservative Treatment

Objective: This study aims to evaluate the surgical technique, indications, and clinical outcomes of facial nerve decompression performed via the transcanal endoscopic approach (TEA) for traumatic facial paralysis caused by temporal bone fracture. Given the anatomical constraints of TEA, this study targets patients with lesions limited to the tympanic segment and/or geniculate ganglion to provide preliminary evidence of its feasibility. Methods: A retrospective analysis was conducted on 6 patients with traumatic facial paralysis refractory to conservative treatment who were admitted between January 2021 and February 2024. All patients underwent facial nerve decompression via TEA, during which the surgical procedure steps were recorded. In addition, facial nerve function was assessed using the House-Brackmann (HB) grading system preoperatively and postoperatively, and pure-tone audiometry was used to compare audiological results. Results: All 6 patients underwent preoperative evaluation with temporal bone high-resolution computed tomography. Of these patients, 5 had injuries located at the geniculate ganglion and 1 at the tympanic segment. Preoperatively, the facial nerve function of the patients was graded as grade V in 5 patients and grade IV in 1 patient. All patients had an electroneurography value of ≥90%. At 6 months postoperatively, facial nerve function improved to HB grade I in 4 patients and grade II in 2 patients, and the overall improvement was statistically significant ( P = .024). For audiological outcomes, both the postoperative air-bone gap and air-conduction thresholds improved significantly compared with preoperative values (both P = .028), whereas bone-conduction thresholds showed no significant change ( P = .197). Conclusion: For patients with traumatic facial paralysis whose lesions are confined to the tympanic segment and/or geniculate ganglion and who fail conservative therapy, TEA may represent a feasible and minimally invasive salvage option.