Facial nerve paralysis after intratemporal and extratemporal blunt trauma

Definitive facial nerve paralysis by intratemporal and extratemporal blunt injury is uncommon. Facial palsy as a result of closed temporal trauma is assumed to result if a petrous or temporal fracture is produced. Injury of the extratemporal trunk is extremely rare, but peripheral branches can be more easily injured. An exhaustive examination is necessary for an assessment if facial nerve damage is inside its bony canal or if it is severed distal to the stylomastoid foramen. Evaluation of facial muscle tone and motion, tear production, taste distribution, and stapedius muscle function must be evaluated. Electroneurography is mandatory because it is an important prognosis factor. Many prognosis factors must also be considered. Computed tomographic scan is also mandatory for providing localization of temporal fractures. Of 30 patients with facial paralysis registered by us between 1991 to 1996, 5 (17%) blunt trauma was the cause. In 2 of these patients with facial paralysis by extratemporal injury, showing selective facial branch injuries (one in the buccal branch and another in the marginal mandibular branch), recovery was complete and spontaneous. Another patient presented with a definitive selective buccal branch palsy after a complete facial paralysis produced by blunt preauricular injury. Of another 2 patients with facial paralysis by intratemporal injury without fracture, 1 recovered and the other did not. In 4 of the just-mentioned 5 patients, prednisolone was prescribed 1 week after trauma; no patients underwent surgical treatment. In conclusion, an extratemporal blunt trauma can produce a temporary facial palsy or paresis by injury of the main trunk or peripheral facial branch; however, recovery is usually complete. Intratemporal closed trauma with or without temporal fractures can produce a definitive facial nerve paralysis; recovery is uncertain.