Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review

Abstract

Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

Post Traumatic Mask Face, Diagnostic Dilemma in Bilateral Traumatic Facial Palsy. Case Report

“…transverse fractures and longitudinal fractures. 3,5,7,10,12 Literature review shows greater incidence of facial nerve injury in transverse fractures than longitudinal fractures, i.e.60-70 percent and 20-30 percent respectively.…”

“…1,2 But bilateral temporal bone traumatic fracture with bilateral facial palsy is very rare, and also a diagnostic dilemma because of not early recognition of facial asymmetry.Most patients with bilateral facial palsy due to trauma had serious underlying skull base fractures, which can lead to cerebrospinal fluid leak and also can lead to hearing loss, and for this reason, such patients should always be admitted in a Neurointensive care unit for further management and proper work up for severity of injury. 1,3,5 Second most vulnerable nerve in head injury is facial nerve, with olfactory nerve being the first, and one reason for this is the tortuous bony course in the skull base and temporal bone. 8,9 Broadly temporal bone fractures are of two types, i.e.…”

“…Transverse fractures and longitudinal fractures. 3,4,5,8 There is a greater incidence of facial nerve injury in transverse temporal bone fracture than longitudinal temporal bone fractures, i.e.60-70 percent to 30-40 percent respectively . 8,9 Being the thickest and its pyramid shape much force is needed to fracture the temporal bone, i.e.…”

“…1,5,10,11. The facial nerve (7 th N) is one of the twelfth cranial nerve which has dual functions, both motor and sensory (nervous intermedius). 2,4,5,12 The facial nerve is located between pons and medulla oblongata proximally and more distally in front of the hindbrain.The vestibulocochlear nerve is medial to facial nerve as it enters internal acoustic meatus in the petrous temporal bone. 5 When the facial nerve enters into the middle ear, than on its medial wall also form sensory geniculate ganglion.Extra cranially through the stylomastoid foramen and parotid gland, gives rise to its branches, both motor and sensory.…”

“…2,3,4 These all helps in early detection and further management of facial nerve injury. 5,6,7,11 We presented a case of 18years old male who had road traffic accident on 29.10.2018. This patient suffered with the head injury with bleeding from nose and right ear.…”