Abstract
The temporal bone is often affected in basilar skull fractures. Fractures involving the petrous portion are particularly significant, as they may be associated with neurovascular sequelae. Bilateral facial paralysis secondary to bilateral temporal bone fracture is a rare clinical entity, even more so when associated with other cranial nerve damage such as abducens nerve paralysis and hearing impairment. Only 4 similar cases have been reported in the literature to date. In this paper, we describe a 28-year-old male patient with bilateral facial paralysis, unilateral abducens palsy, and bilateral hearing loss due to bitemporal fractures that developed after a motor vehicle accident. Conservative management was preferred. The 6-month follow-up showed remarkable improvement. This report highlights the effectiveness of conservative management in posttraumatic complete facial and abducens palsy.
Highlights
Academic Editor: Ingo Todt e temporal bone is often affected in basilar skull fractures
We describe a 28-year-old male patient with bilateral facial paralysis, unilateral abducens palsy, and bilateral hearing loss due to bitemporal fractures that developed after a motor vehicle accident
Computed tomography (CT) is the best procedure for detecting the fracture line and for assessing any associated lesions within the temporal bone. e abducens nerve palsy usually recovers spontaneously, but there is controversy concerning the management of traumatic facial paralysis (FP)
Summary
A 28-year-old man was admitted after a motor vehicle accident with thoracic and craniofacial impacts. e patient was conscious, disoriented but cooperative. A bilateral Charles Bell’s phenomenon was noted, as well as an abduction deficit on the left eye (Figures 1(a) and 1(c)). E pure tone audiometry showed a right cophosis and a left mixed hearing loss. An ophthalmological exam with a Lancaster test revealed a left abducens palsy. At the two-week follow-up, after the stabilization of the patient, we noticed a remarkable improvement concerning the right side of the facial palsy, becoming a grade 2 H–B (Figure 3)(a), which encouraged to pursue with the conservative approach. Six months after the accident, the patient exhibited H–B grade 1 recovery on the right and H–B grade 2 recovery on the left side (Figure 3)(d). E audiometry showed a moderate right neurosensorial hearing loss (NSHL) and a mild left NSHL Six months after the accident, the patient exhibited H–B grade 1 recovery on the right and H–B grade 2 recovery on the left side (Figure 3)(d). e hearing on the other hand had improved partially. e audiometry showed a moderate right neurosensorial hearing loss (NSHL) and a mild left NSHL
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