Bilateral Traumatic Facial Paralysis with Hearing Impairment and Abducens Palsy

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.

Figure 1

(a) Bilateral Charles Bell's phenomenon with mask-like face. (b) Left ear hemotympanum. (c) Left abducens palsy.

Figure 2

Transverse section of cranial CT (plane of incudomalleolar joint) showing right longitudinal otic-sparing temporal bone fracture (yellow arrows) and left transverse temporal bone fracture (red arrows).

Figure 3

(a) Two-week follow-up: improvement of the right-side facial palsy. (b) Two-month follow-up: development of the mouth movement exhibiting the progressive return of function of the lower branches of the facial nerve. (c) Two-month follow-up: recovery of the left abducens palsy. (d) Six-month follow-up: evolution of the bilateral facial paralysis.