Facial nerve paralysis secondary to mandibular fracture

When facial nerve paralysis complicates a mandibular fracture, it may be difficult to locate the point of injury, since the nerve may be injured in the fallopian canal by a secondary temporal bone fracture or in soft tissue by mandibular fragments. Following a review of eight previously reported cases, this paper presents two additional cases, one with bilateral, complete paralyses and the other with a unilateral paresis. In the first, the condyles were driven posteriorly, resulting in bilateral temporal bone fractures, a unilateral external canal stenosis, and a unilateral sensorineural hearing impairment. Good functional return followed decompression of the intratemporal facial nerves. In the second patient, facial function returned spontaneously. When the temporal bone is fractured, therapy follows guidelines for facial paralysis associated with basilar skull fractures from other causes. If soft tissue injury is suspected, the decision must be made whether to explore the nerve or wait for spontaneous recovery.