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Updated: Aug 13, 2026

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
[Bilateral sixth nerve and left third nerve palsy after head trauma]
N Ruiz-de-Río1, A Arbizu-Duralde, P Miranda-Lloret
1Hospital Universitario La Paz, Madrid, Spain. noeruizdelrio@yahoo.es
Case Report:
To describe a case of combined bilateral cranial nerve palsy of traumatic origin. To determine the lesions that produce the symptoms is useful to define the final prognosis and the best treatment.
Discussion:
We report the case of a patient who developed a bilateral sixth nerve and left third nerve palsy after head trauma. The underlying lesion was a diffuse axonal injury. After an observation period during which no spontaneous improvement occurred, we administered botulinum toxin with a successful clinical result. Bilateral combined traumatic cranial nerve palsies are rare. When a diffuse axonal injury is present, the chance of spontaneous resolution is poor.
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