Facial Nerve Reanimation

Immediate onset paralysis due to fracture of mastoid (temporal bone) requires surgery (decompression, re-anastomosis or cable nerve graft).

Ans is ‘a’ i.e. Immediate repair

During mastoidectomy, when the facial nerve is injured, it is immediately explored. Injury to greater than 50% of the neural diameter of the facial nerve is addressed either with primary reanastomosis or reconstructed with the use of a nerve graft. Complete recovery of nerve function is uncommon in these cases.

Ans. C Immediate mastoid exploration

Facial Palsy and CSOM

In CSOM, facial palsy may be due to erosion of fallopian canal by cholesteatoma (which erodes fallopian canal) osteitis, or demin¬eralization. The treatment should be urgent mastoid exploration, with decompression of the facial nerve in the fallopain canal.

1. However, the scenario is not the same in ASOM. An acute inflammatory process cannot effectively erode the bony falopian canal within the short period of time. Hence, the only possibility in a patient with ASOM to develop facial palsy is the presence of a congenitally dehiscent fallopian canal (facial nerve without a bony canal), which is the commonest congenital maliformation of temporal bone .
2. Thus in this case the treatment is myringotomy to relieve pressure on the exposed nerve or sometimes cotical mastoidectomy.

Crocodile tears (gustatory lacrimation) There is unilateral lacrimation with mastication

• It is due to faulty regeneration of parasympathetic fibres which normally travel through chorda tympani but are misdirected towards greater superficial petrosal nerve and instead of going to salivary glands reach the lacrimal glands. This results in unilateral lacrimation with mastication
• Treatment – Sectioning the greater superficial petrosal nerve or tympanic neurectomy

• Frey’s syndrome (gustatory sweating) -There is sweating and flushing of skin over the parotid area during mastication.