Introduction: The identification of the most appropriate therapeutic approach to be adopted in cases of direct or indirect lesion of the facial nerve is still matter of discussion. Hypoglossal-facial anastomosis is generally chosen in reconstructive surgery, while facial nerve decompression is indicated in traumatic and inflammatory diseases (especially temporal bone fractures). Objectives: To find the best therapeutic strategy to adopt in case of post-traumatic facial nerve palsies underlining the role carried out by clinical, radiological and electrophysiological information. Methods: Between 1989 and 2001, 32 patients affected by post-traumatic facial nerve palsy have been examined. In a limited group of patients (29) with longitudinal fracture a multivariate statistical analysis has been performed in order to find unfavourable prognostic factors. Results: Among 16 patients submitted to a transmastoid extra-labyrinthine facial nerve decompression, in 75% of the cases a satisfactory functional recovery (grade I-II according to House-Brackmann classification) has been achieved. Conclusions: It is not easy, even due to methodologic reasons, to get a number of patients great enough to definitively clarify many controversial aspects regarding the best surgical treatment of facial nerve palsies. A multicentric recruitment and observation of this rare kind of disease could contribute in that direction; moreover, it will be very important the possibility to reach a larger standardization of all clinical parameters useful in the complete comprehension of the problem, eventually with the utilization of Consensus Conferences.