Facial nerve injury after temporal bone trauma is becoming an increasing problem. Because of development of modern industry and social activity people face an ever increasing risk of head trauma. In the past years, the era of simple X-ray, it was hard to diagnose and treat the temporal bone fracture and facial paralysis but recent advances in temporal bone imaging such as high resolution temporal bone CT, facial nerve management and surgical skills resulted in improved care for facial nerve paralysis with temporal bone fracture. However management for facial paralysis is still a topic of debate and the controversy is centered on surgical intervention. To evaluate results of surgical decompression for facial paralysis with temporal bone fracture, we reviewed 18 cases retrospectively and compared the results according to surgical timing after trauma, type of paralysis and many other factors. All procedures of surgical decompression were performed transmastoid or combined with extralabyrinthine approach. The functional recovery of early decompression is better than that of later decompression. The type of paralysis and with or without epineural slitting seems not to be closely related the recovery rate.