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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) faci...
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Bilateral Facial Nerve Paralysis (FNP) due to the temporal bone fracture is rare condition. Management of
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Citations
... Teknik Facial Nerve Decompression via Transmastoid didapatkan pada penelitian Eliçora et al., 2015 dengan mempertimbangan apakah mengenai gangguan pendengaran atau tidak. Jika terdapat gangguan pendengaran bisa dilakukan langsung Facial Nerve Decompression via trans Labirinth (Eliçora et al., 2015). Sedangkan pada teknik Middle Cranial Fossa dilakukan jika fungsi pendengaran masih baik (Parrino et al., 2022). ...
... Berdasarkan hasil penelitian (Eliçora et al., 2015) pada seorang pasien yang secara langsung mendapatkan paralisis fasialis bilateral akibat trauma tumpul kepala. Pasien ini mengalami fraktur transversal pada tulang temporalnya akibat trauma tersebut. ...
... Pendekatan operasi yang dilakukan pada sisi kanan pasien adalah menggunakan facial nerve decompression transmastoid karena adanya penurunan pendengaran . Observasi setelah satu tahun operasi pada sisi kanan pasien didapatkan penurunan derajat kelumpuhan pasien mencapai HB I. Sedangkan pada sisi kiri pasien yang tidak dilakukan pembedahan hanya mencapai HB II setelah satu tahun terapi konservatif dan medikamentosa (Eliçora et al., 2015). ...
Facial nerve paralysis is a common event in cases of cranial base trauma. Especially facial nerve paralysis due to trauma or fracture of the temporal bone accounts for around 7-10% of cases. Analysis of studies related to the management of facial nerve paralysis due to skull base fractures still needs to be studied. The aim of this paper is to examine in more depth the management of facial nerve paralysis due to traumatic skull base fractures. This research analyzes studies through the PubMed, Google Scholar, and Proquest databases. After searching, 729 articles were found. Seven articles were found that were suitable and discussed the management of facial nerve paralysis due to cranial base trauma. Based on the results of the investigation, it was found that the management carried out was based on the severity scale of facial paralysis where medical or surgical treatment could be carried out according to the required indications.
... Bilateral facial nerve paralysis is a rare entity, corresponding to less than 2% of all facial palsy cases. 1 The most important causes are trauma, infectious diseases (eg, mononucleosis, syphilis, Lyme disease, bilateral otitis media, and bilateral Herpes-Zoster), neurological diseases (eg, multiple sclerosis, stroke, and neoplasms), and diseases which remain with uncertain etiologies, such Guillain-Barre syndrome, Melkersson-Rosenthal syndrome, sarcoidosis, and leukemia. 2 Cranial trauma associated with temporal bone fractures is responsible for 3% of all facial palsy (FP) cases, which can be traditional divided into longitudinal, transverse, and mixed fractures. 2 Recently, a new classification was proposed based on the otic capsule, dividing the fractures into otic capsule sparing and otic capsule disrupting. ...
... 2 Cranial trauma associated with temporal bone fractures is responsible for 3% of all facial palsy (FP) cases, which can be traditional divided into longitudinal, transverse, and mixed fractures. 2 Recently, a new classification was proposed based on the otic capsule, dividing the fractures into otic capsule sparing and otic capsule disrupting. 3 The importance to classify the fracture type relies on its prediction of the severity of the signs and symptoms the patient can develop. ...
When temporal bone fractures are associated with facial palsy (FP) evolution the medical team have no much time to make a decision: to do or not to do a surgical approach? How to evaluate the necessity? When to do it and when is the correct time?
... mononucleosis, syphilis, Lyme disease, bilateral otitis media, bilateral Herpes-Zoster), neurological diseases (e.g. multiple sclerosis, stroke and neoplasms) and diseases which remain with uncertain aetiologies, such Guillain-Barre syndrome, Melkersson-Rosenthal syndrome, sarcoidosis, leukaemia (2). ...
... Cranial trauma associated with temporal bone fractures are responsible for 3% of all facial palsy (FP) cases, which can be traditional divided into longitudinal, transverse and mixed fractures (2). Recently, a new classification was proposed based on the otic capsule, dividing the fractures into otic capsule sparing and otic capsule disrupting (3). ...
... Electro-diagnostic studies can be used in patients with traumatic facial palsy primarily to determine the prognosis. 18 It helps in delineating if there is neuropraxia, axonotmesis, neurotmesis or nerve transection. Neuropraxia is the mildest form and characterised by conduction block due to myelin damage alone and axonal sparing; hence the recovery too is rapid and adequate. ...
... There are variety of electrodiagnostic tests for facial nerve, which rely on stimulation of nerve percutaneously adjacent to the stylomastoid foramen. 18 In both nerve excitability test and electroneurography, the comparison of paralysed side is done with normal side in terms of threshold and response, respectively. Thus, it was not possible in our case as ours was bilateral paralysis. ...
Facial paralysis is a potentially disabling complication of temporal bone fractures. Although unilateral palsy is commonly encountered, bilateral facial nerve palsy is rare, especially in post-traumatic situations. Other recognised causes of bilateral facial palsy are neurologic, infectious, neoplastic, idiopathic or metabolic disorders. A 25-year-old male patient presented with difficulty in talking, eating and closing eyes for 15 days since a post-vehicular accident. CT of skull showed bilateral longitudinal temporal bone fractures. Bilateral facial palsy was confirmed by clinical and topodiagnostic tests. Patient was given a course of steroids which led to an early improvement on left side followed by a delayed right-sided improvement at 6 months.
... Although the idiopathic bilateral involvement of the nerve (Bell's palsy) is a diagnosis of exclusion, which occurs in 20% -23% of the cases, serious life threatening conditions (metabolic, immunologic, toxic, infectious, vascular, etc.) should be ruled out prior to the establishment of the diagnosis (8). According to the article by Elicora et al. bilateral facial paralysis caused by bitemporal bone fractures is very rare, with eight cases reported to date (9). ...
... However, complete paralysis with more than 95% degeneration is managed by facial nerve exploration (13,14). For example, in the Elicora et al. study, patients with complete facial paralysis were treated via the surgical method (nerve decompression) with good results (9). In the Hwang study, the patient was placed on corticosteroids, while in the Hwang et al. and Ramamoorthy and Kumaran study they used methylprednisolone and oral steroids for treatment, and achieved good results (4,10). ...
Introduction
Although bilateral facial nerve palsy is a rare condition, its etiology is more detectable than the unilateral type. A temporal bone fracture is one cause of bilateral facial nerve palsy, contributing in 3% of the cases.
Case Presentation
Here, we report the case of a 35-year-old man complaining of bilateral incomplete eye closure, two weeks after a closed head injury caused by a motor vehicle accident.
Conclusions
The high resolution computed tomography findings revealed a bilateral temporal bone fracture line, which extended to the fallopian canal. With regard to treatment, near complete recovery was obvious after two weeks of treatment with oral corticosteroids. Overall, bilateral facial palsy is hard to diagnose; therefore, clinical suspicion and the early detection of facial nerve injuries is necessary for good nerve recovery in temporal bone fractures.
Facial palsy (FP) is a known consequence of head trauma, manifesting either immediately at the time of injury or with delayed onset, typically occurring 2 days or more post-trauma. Unilateral FP is the more common presentation and is often attributed to partial or complete transection of facial nerves or delayed onset edema. Conversely, bilateral facial palsy is a rare occurrence, reported in only a small number of cases, accounting for approximately 3% of patients presenting with bilateral weakness. In this report, we present the case of a previously healthy 28-year-old female who suffered a closed head injury during the Beirut Port Blast. Four days following the incident, the patient exhibited right-sided peripheral FP, which was consistent with a right temporal bone fracture. Subsequently, on the fifth day, the right-sided FP worsened, accompanied by the development of new FP on the left side, characterized by sparing of the frontal region, indicating a central origin for the left-sided FP. Laboratory investigations revealed severe hypovolemic hyponatremia with a sodium level of 105 mmol/L. As isotonic saline fluid replacement was initiated, there was progressive improvement in the left-sided FP. The right-sided palsy also resolved gradually with the implementation of facial rehabilitation therapy. It is important to note that severe head trauma, particularly with a concussive injury, can lead to facial paralysis through various mechanisms. Furthermore, severe hyponatremia should be considered a potential cause of central facial palsy, particularly in the presence of bilateral facial involvement. A thorough evaluation is encompassing assessment of palsy patterns, comprehensive imaging studies, and metabolic investigations is crucial for accurate diagnosis and timely intervention, resulting in successful treatment.
Introduction:
Bilateral facial nerve (FN) palsy due to temporal bone fracture is a rare clinical entity, with few cases reported. The choice between conservative and surgical treatment is more complex than in unilateral cases.
Materials and Methods:
A thorough search of the available literature on trauma-related bilateral FN palsy revealed 22 reports. Our own experience is also described.
Results:
All bilateral delayed- and unknown-onset cases were treated conservatively, with a good recovery rate (70.5%). Surgery was performed on 6 sides within the immediate-onset group, with a good recovery rate (83.3%).
Conclusions:
In the management of traumatic FN palsy, the main controversial issue focusses on indications for surgery as well as timing and type of approach. In bilateral cases, it is more challenging to make the right choice, due to lack of facial asymmetry and/or state of unconsciousness following severe trauma. Electro-diagnostic tests and high-resolution computed tomography are essential for decision-making.
Facial nerve palsy (FNP) can be a challenging medical condition, and bilateral FNP is an uncommon occurrence that is potentially fatal and warrants urgent medical intervention. We report a rare case of bilateral FNP that developed after traumatic brain injury (TBI), which we approached through an electromyographic study. A 23-year-old male patient had experienced a fall-down injury from height of 4 meters while on his military service. Computed tomography of the brain and facial bone showed acute TBI and multiple skull base fractures. Limited facial expression and dysarthria started at the time of cranioplasty, which was about 3 months after the patient’s initial presentation, and these symptoms gradually deteriorated over time. An electrodiagnostic study demonstrated incomplete bilateral facial nerve lesions, which were strongly indicated as lower motor neuron lesions. An early diagnosis based on electrodiagnostic study should be considered for proper treatment, which can achieve optimal functional recovery after bilateral FNP.
The force required to fracture the temporal bone is substantial and can lead to vascular injury, hearing loss, vertigo or imbalance, facial nerve injury, and cerebral spinal fluid leaks. Various classification schemes have been proposed, with those identifying critical structures being more useful. CT remains the imaging modality of choice. Hearing loss remains the most common complication while facial nerve paralysis continues to be one of the most dreaded consequences. This chapter discusses the epidemiology of temporal bone trauma, the pathophysiology as well as complications, and current recommendations in management.
