Delayed bilateral facial nerve palsy following crushing head injury

Abstract

A 49-year-old man who works for a paper mill was admitted for bilateral severe rhinorrhea and otorrhea due to a crushing head injury. In the accident, his head was compressed bilaterally by a paper compressor at the temporal region. Upon admission, his consciousness was dull and he had no other neurological symptoms such as cranial nerve palsy. CT scan revealed marked pneumocephalus, fluid collection in the bilateral sphenoidal sinuses and nasal cavities, but not in the internal auditory meatuses. Bone CT detected a clival fracture, while the bilateral pyramidal bones were intact. MRI did not detect any cerebral parenchymal damage or nerve damage. He recovered full conscious, but, bilateral facial palsy (House-Brackman grade IV) appeared 12 days after the head injury. Predonisolone and vitamin B12 were immediately administered. Facial palsy on the right side completely disappeared 48 days after injury. The patient experienced difficulty in closing his eyes and the salivation and stapedial reflexes disappeared. Based on the clinical findings, the facial nerves in the fallopian canals were concluded to have been injured. We will describe the present case and discuss the mechanism underlying traumatic facial nerve palsy without pyramidal bone fracture due to low velocity crushing head injury.