Repeated episodes of acute idiopathic facial paralysis present both a diagnostic and a management dilemma. We discuss these issues with reference to four adult cases managed between 1999 and 2008, thus adding to the sparse literature on this subject. For such cases, our unit performs decompression of geniculate, labyrinthine and meatal segments of the facial nerve via a middle fossa approach. A short video, available on The Journal of Laryngology & Otology website, demonstrates the key stages of the operation.
We believe there is a role for surgical decompression in cases of recurrent acute facial weakness with three or more documented episodes, especially in the presence of progressive deterioration in function. Decompression of the geniculate, labyrinthine and meatal segments, via a middle fossa approach, is our favoured technique, and has achieved good results.