Objectives: The surgical timing and approach for patients with Bell's palsy and complete facial paralysis is controversial. A previous meta-analysis demonstrated no benefit from surgical decompression, however, only transmastoid decompression (TMD) was investigated. No study has evaluated both the outcomes of TMD and middle fossa decompression (MFD).
Study design: Systematic review with meta-analysis.
Methods: A systematic literature search identifying all studies meeting inclusion criteria and published between 1985 and 2015 was performed. Final House-Brackmann (HB) scores were calculated and compared for TMD, MFD, and medical controls. A meta-analysis was performed to compare MFD less than or equal to 14 days versus MFD more than 14 days, TMD versus medical controls, and surgical therapy (combined MFD and TMD) versus medical controls. Observational studies without a control arm were excluded from the meta-analysis.
Results: Average HB scores for MFD less than or equal to 14 days was 1.8, MFD more than 14 days was 2.75, and MFD medical controls was 2.4. For TMD average HB was 2.3 and for TMD medical controls average HB was 2.4. 75% MFD were performed within 14 days of onset while TMD was performed between 15 and 120 days. Meta-analysis demonstrated significantly better facial nerve outcomes for MFD performed less than or equal to 14 days versus more than 14 days (p < 0.001), but no difference between TMD versus medical controls (p = 0.78) or surgical therapy versus medical controls (p = 0.58).
Conclusion: MFD performed within 14 days of symptom onset results in better facial nerve outcomes than MFD performed after 14 days. TMD does not offer improved outcomes over medical management however decompression was only offered after 15 days of symptom onset.