Well-selected cases of facial nerve paralysis may be favorably influenced by decompression. The transcutaneous nerve excitability test is very important for the selection of these cases. The arguments in favor of surgery in well-selected cases of Bell's paralysis are discussed. It is stressed that decompression should be achieved by opening the nerve sheath. Compression does not take place inside the bone, but inside the nerve sheath of the vertical part whose strong concentric layers of collagen fibers surround the nerve like a strait jacket. in its horizontal part and proximal to the geniculate ganglion, decompression is not indicated since the nerve sheath is formed by elastic fibers.