A case of facial nerve palsy caused by severe head injury treated by translabyrinthine approach

Abstract

Background: Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial.

Case description: A 57-year-old man was admitted to our hospital with head trauma due to a fall injury. A total body computed tomography (CT) scan showed a left frontal acute epidural hematoma associated with a left optic canal and petrous bone fractures with the disappearance of the light reflex. Hematoma removal and optic nerve decompression were performed immediately. The initial treatment was successful with complete recovery of consciousness and vision. The facial nerve paralysis (House and Brackmann scale grade 6) did not improve after medical therapy, and thus, surgical reconstruction was performed 3 months after the injury. The left hearing was lost entirely, and the facial nerve was surgically exposed from the internal auditory canal to the stylomastoid foramen through the translabyrinthine approach. The facial nerve's fracture line and damaged portion were recognized intraoperatively near the geniculate ganglion. The facial nerve was reconstructed using a greater auricular nerve graft. Functional recovery was observed at the 6-months follow-up (House and Brackmann grade 4), with significant recovery in the orbicularis oris muscle.

Conclusion: Interventions tend to be delayed, but it is possible to select a treatment method of the translabyrinthine approach.

Keywords: Facial nerve reconstruction; Greater auricular nerve graft; Mastoidectomy; Severe head trauma; Translabyrinthine approach.