Facial canal decompression leads to recovery of combined facial nerve paresis and trigeminal sensory neuropathy - Case report

BACKGROUND Trigeminal sensory neuropathy is often associated with facial idiopathic ne rve paralysis (Bell's palsy). Although a cranial nerve viral polyneuropathy has been proposed as the usual cause, in many instances the etiology remai ns unclear. This case report of recovery of both trigeminal and facial neur opathy after surgical decompression of the facial nerve suggests an anatomi c link. METHODS A case of a 39-year-old woman presenting with recurrent unilateral facial p aralysis is summarized. Her fifth episode, which did not spontaneously reco ver, was associated with retroorbital and maxillary pain as well as sensory loss in the trigeminal distribution. RESULTS A middle cranial fossa approach for decompression of the lateral internal a uditory canal, labyrinthine segment of the facial nerve and the geniculate ganglion was performed. The patient's pain and numbness resolved immediatel y postoperatively, and the facial paralysis improved markedly. CONCLUSION This result implicates a trigeminal-facial reflex as hypothesized by others . It suggests that decompression of the facial nerve can lead to improvemen t in motor and sensory function as well as relief of pain in some patients with combined trigeminal and facial nerve dysfunction. (C) 1999 by Elsevier Science Inc.