The facial nerve extends from the base of the skull, winds around the ear, passes through the salivary gland, and divides into many branches that connect to various facial muscles, the tear gland, and the tongue. Sometimes the facial nerve becomes compressed, usually behind the ear, due to inflammation from a viral infection, tumors, or injury. If the nerve sustains damage as a result of such compression, symptoms including facial weakness, paralysis, spasms, and twitching can manifest. Other consequences may include inability to properly close the eye, excessive tearing, drooling, and inability to taste certain foods. (see Facial Nerve Disorders for further information)
Antiviral medications, antibiotics, or steroids may be prescribed to stop infection, reduce swelling, and improve circulation to the area. In certain cases medical treatment is insufficient, however, and surgery may be performed to relieve the pressure on the facial nerve. Decompression is achieved by removing bone around the involved area, usually behind the ear.
Different procedures may be performed depending on the cause of compression, location of damage, and other factors.
Mastoid Decompression of the Facial Nerve – An incision is made behind the rigid mastoid (the bone behind the visible part of the ear) around the swollen nerve, and bone is removed. This operation is performed in cases of paralysis when the nerve function is deteriorating. General anesthesia is used, and patients should expect to stay in the hospital for 2 to 4 days. Recovery may take 3 to 12 months, and may not be complete depending on the degree of nerve damage at the time of surgery. Hearing impairment is not common, but is possible following surgery.
Middle Fossa Facial Nerve Decompression – If deeper portions of the facial nerve are being compressed, surgery may involve an incision above the ear and removal of a small portion of the skull.
Mastoid and Middle Cranial Fossa Facial Nerve Decompression – This operation combines the first two procedures. This combined approach is usually used to decompress the nerve in patients with Bell's palsy.
If facial nerve damage is extensive, a facial nerve graft may be performed. In this procedure, a skin sensation nerve is removed from the neck and transplanted into the ear bone to replace the damaged part of the nerve. Total paralysis will occur after surgery until the nerve grows through the graft, which may take from 6 to 15 months. Some weakness will remain permanently.
The risks and complications associated with facial nerve surgery are very low. At Columbia Presbyterian, our neurotologists have considerable expertise and superior success rates, with very few patients experiencing post-surgical complications.
Immediately after surgery, there is swelling and fluid buildup in the mastoid and middle ear. This causes temporary hearing impairment in the operated ear. As the swelling subsides (usually by 2 to 4 weeks), preoperative levels of hearing are restored. Occasionally, scar tissue forms and causes a permanent hearing loss, but severe impairments are uncommon.
Swelling of the inner ear structures commonly causes dizziness immediately after surgery. Dizziness usually subsides after a few days.
A hematoma, which is a collection of blood under the skin, develops in rare cases. Removal of the clot may be necessary.
Leakage of fluids surrounding the brain occurs very occasionally. Stopping the leak requires a second surgical procedure.
Infection following facial nerve surgery is very rare, but has the potential to lead to meningitis (an infection of the fluid surrounding the brain).
On extremely rare occasions, brain swelling after a middle fossa operation may lead to temporary paralysis of half the body.
The risks associated with anesthesia should also be discussed with the physician, as is the case with any surgical procedure.