Facial Nerve Decompression

Facial nerve decompression is an operation that is designed to relieve pressure on the facial nerve as it courses from the brain out into the face, through a tight bony channel. During the procedure, surgeons make an incision behind the ear, and in the hair bearing area above the ear. Bone is removed from the skull and the mastoid (ear bone) to expose the area where the facial nerve passes, so that the entire course of the facial nerve is identified.  The theory behind the operation is that by unroofing the bony channel, and opening it fully, the nerve will have improved blood supply, less compression, and will be able to recover more quickly. While it is not entirely clear whether this operation is definitely beneficial, there are some data which show that this operation provides benefit.  It is most commonly employed under three circumstances: first, in the initial 12 days after the onset of Bell’s palsy, in a subset of patients who fail certain kinds of electrical tests; second, for patients who demonstrate repeated episodes of facial weakness on one or both sides; and third, when patients experience head trauma and fractures of the temporal bone (ear bone), where there is immediate onset facial weakness at the time of the trauma. Controversy continues to surround whether this operation makes a substantial difference to overall recovery, though there is reasonable evidence to suggest that particularly in the acute Bell’s palsy population, if people meet very strict electrophysiologic criteria, it may help.