Edematous swelling of the facial nerve in Bell's palsy

Surgical decompression of the intratemporal facial nerve from the geniculat e ganglion to the stylomastoid foramen was carried out in 91 patients with Bell's palsy. All of the patients had denervation exceeding 95% and a supra stapedial lesion. Edematous swelling of the nerve was assessed using the fo llowing three grades: + +,nerve swells beyond the bony facial canal; +,nerv e swells beyond the nerve sheath, but within the bony canal, and -, no nota ble swelling observed. Varying degrees of swelling of the nerve were noted in all of the patients From onset to the end of the ninth week. The inciden ce of + + swelling was highest within 3 weeks of onset and then declined. + swelling was most often noted in the vicinity of the geniculate ganglion , and was thought to be a manifestation of inflammation due to herpes simpl ex virus infection. There was a altar time dependency of the swelling in th e horizontal and pyramidal segments, but not in the mastoid segment. After the ninth week, the incidence of swelling decreased sharply and no swelling of the nerve was observed in about one-third of the patients. Considering the etiology and the analysis of edematous swelling, we propose that the co urse of Brill's palsy be differentiated into an acute phase (the first 3 we eks after onset), a subacute phase (from the fourth to ninth weeks) and a c hronic phase (after the tenth week).