Middle cranial fossa facial nerve decompression before two years of age

We present a case report of a 17-month old patient who underwent serial bilateral total facial nerve decompression procedures for complete bilateral facial paralysis in the setting of craniometaphyseal dysplasia via combined middle cranial fossa and transmastoid approaches. The surgical decision-making process and procedures were reviewed. The patient recovered without complications from the staged surgical procedures, and developed partial return of function of both facial nerves postoperatively, with symmetric House-Brackmann grades of II–III. Despite its technical difficulty in the setting of this particular disorder, facial nerve decompression may be appropriate in the setting of acute facial palsy in craniometaphyseal dysplasia, with the potential for return of function. Given the extremely rare nature of the disease process, variable surgical experience and the clinical condition of the patient remain our best guides for management.

我们报告一例17个月大的患者病例，该患者因颅骨干骺端发育不良导致双侧完全性面瘫，通过中颅窝和经乳突联合入路进行了系列双侧面神经全程减压手术。对手术决策过程和手术操作进行了回顾。患者分期手术无并发症恢复，术后双侧面神经功能部分恢复，House - Brackmann分级对称，为II - III级。尽管在这种特殊疾病情况下技术难度较大，但在颅骨干骺端发育不良出现急性面瘫时，面神经减压可能是合适的，具有恢复功能的潜力。鉴于疾病过程极其罕见，不同的手术经验以及患者的临床状况仍然是我们治疗的最佳指导。