ObjectiveToinvestigatetheclinicaloutcomesoffacialneverdecompressionviaacombinedsubtemporal-supralabyrinthineapproachtogeniculateganglionformanagementoffacialparalysisintemporalbonefracture.MethodsEighteenpatientswithunilateralfacialparesisduetotemporalbonefractureweretreatedbetweenMarch2003andMarch2011.FacialfunctionwasHouse-Brackmann(HB)gradeⅢin6patients,HBgradeⅤin9patientsandHBgradeⅥin3patients.Thepreoperativemeanairconductionthresholdwas52dBHLforthe15caseswithlongitudinaltemporalbonefractureandshowedseveresensorineuralhearinglossinthe3caseswithtransversetemporalbonefracture.Fracturelinesweredetectedin15casesontemporalboneaxialCTscansandossiculardisruptionwasdeterminedin11casesbyvirtualCTendoscopy.Thegeniculateganglionorthetympanicmastoidsegmentofthefacialnerveshowedanirregularmorphologyoncurvedplanarreformationimagesofthefacialnervecanal.Afteranintactcanalwallmastoido-epitympanectomy,theossicularchaindamagewasevaluated.Iftheossicularchainwasintact,thesupralabyrinthinerecesswasopenedbydrillingthroughthecellsbetweenthetegmentympaniandossicularchain.Iftheossicularchainwasdisrupted,theincuswasremovedtoaccessthesupralabyrinthinerecess.Thegeniculateganglionandthedistallabyrinthinesegmentofthefacialnervewereexposed.Aftercompletingfacialnervedecompression,thedislocatedincuswasreplaced,orafracturedincuswasreshapedtobridgethespacebetweenthemalleusandthestapes.ResultsPronouncedgangliongeniculatumswellingwasfoundin15casesoflongitudinaltemporalbonefracture,withgreaterpetrosusnervesdamagein3casesandbleedingin5cases.Disruptedossicularchainswereseenin11cases,includingdislocatedincusresultingincrushingofthehorizontalportionofthefacialnervein3casesandfractureoftheincuslongprocessin1case.In3casesoftransversefractures,
