Endoscope-assisted facial nerve decompression for traumatic tympanic segment of facial nerve paresis

Traumatic facial nerve paresis is an undesired sequel following temporal bone fractures. The choice of surgical approach for this condition is largely dependent on the site of the lesion. A 33-year-old woman presented with delayed facial nerve paresis following a motor vehicle accident, which did not show any improvement with conservative treatment for 3 months. Preoperatively, she had facial nerve paresis House–Brackmann grade V. She underwent endoscope-assisted facial nerve decompression involving the tympanic segment of the facial nerve. A standard postauricular mastoidectomy was performed. The mastoid segment of the facial nerve was identified but there was no obvious fracture or bony spicule seen. An extended posterior tympanotomy was done and endoscope was used by way of this corridor to examine the tympanic segment of the facial nerve until the second genu which appeared to be emaciated with lack of lustre. Finally, neurolysis was done under endoscopic guidance. She regained significant improvement in her facial nerve function 8 months postoperatively to House–Brackmann grade II.