Present management of facial paralysis associated to petrous bone fracture

After almost a century of being well known, there is still no consensus concerning to the management and surgical indications in patients with post-traumatic facial paralysis. The main objective of this study was to find a possible relationship between the details of the skull fracture provided by high-resolution CT scan and the onset and evolution of facial paralysis. A second aim was to validate the management protocol used in our department. We performed a prospective study on 216 patients diagnosed during three consecutive years. We found 111 petrous bone fractures and classified them according to the high-resolution CT into two types of longitudinal, three types of transverse and one type of oblique or mixed fracture. We observed good results (House Grades I to III) in 91,3% of the patients, with only two surgical indications. One of the longitudinal types of fracture showed an statistically significant relationship with the onset of paralysis. Among all the parameters considered, only the time of onset revealed as an important prognosis factor. We discuss our results and by reviewing the literature draw our conclusions. We emphasize the utility of conservative treatment in the management of this pathology.