Facial nerve paralysis after intratemporal and extratemporal blunt trauma

Area of Science:

• Otolaryngology
• Neurology
• Trauma Surgery

Background:

• Definitive facial nerve paralysis from blunt injury is uncommon.
• Facial palsy from closed head trauma usually involves temporal bone fractures.
• Injury to the extratemporal facial nerve trunk is rare, but peripheral branches are more vulnerable.

Observation:

• Comprehensive evaluation including facial muscle function, tear production, taste, and stapedius reflex is crucial.
• Electroneurography and computed tomographic scans are essential for prognosis and fracture localization.
• Prednisolone was used in 4 out of 5 blunt trauma cases, with no surgical interventions.

Findings:

• Extratemporal blunt trauma can cause temporary facial palsy or paresis, with generally complete recovery.
• Intratemporal blunt trauma, with or without fractures, can result in definitive facial nerve paralysis and uncertain recovery.
• Selective peripheral branch injuries (buccal, marginal mandibular) showed complete spontaneous recovery.

Implications:

• Accurate diagnosis differentiating intratemporal vs. extratemporal injury is key for predicting facial nerve recovery.
• Non-surgical management with corticosteroids may be considered for blunt facial nerve trauma.
• Further research is needed to optimize treatment strategies for traumatic facial nerve palsy.