Question: A 42 year old woman presents for evaluation of facial paralysis. She noticed rapid onset of complete right sided facial paralysis within 24 hours of paresis developing. She is now 5 days from initial onset. Bell’s palsy is suspected. She undergoes electroneuronography that demonstrates 94% degeneration compared to the normal side. EMG shows evidence of voluntary motor activity. Which of the following is the next best step in management?

a) Middle fossa approach and decompression of the labyrinthine segment of the facial nerve

b) Repeat electrical testing in 5 days

c) Corticosteroids and antivirals

d) Decompression of the mastoid segment of the facial nerve

[Answer will be posted with next week's new question]

Answer to last week's question, “Features” (March 6, 2022)

B - Superomedial vector of spread.