Post-traumatic bilateral facial paralysis associated with temporal bone fracture

Abstract

Bilateral traumatic facial paralysis is a very rare clinical condition. Loss of taste sensation, associated with bilateral traumatic paralysis, is even rarer and has not been well described in the literature. In this report, a 23-year old male, who developed bilateral facial paralysis with loss of taste sensation and hearing impairment, following a motor vehicle accident, is presented. He had initially presented with unconsciousness for about 2 hours after he sustained closed head injury after a motor vehicle accident. Initial Computed Tomography (CT) scans revealed a small epidural hematoma, right temporal bone fracture and air densities around the basal cistern. On the 4th day after trauma, he was noted to have incomplete closure of both eyes and was feeling difficulty with chewing and drooling of saliva. Electrodiagnostic testing confirmed the diagnosis of bilateral facial paralysis-House-Brackmann (HB) grade V. Electroneuronography (ENoG) showed degeneration of 90% nerve fibres bilaterally. The high-resolution CT scans showed bilateral temporal bone fractures. At 3 months of follow-up, the patient had partial recovery of facial nerve function bilaterally and improvement in HB classification to grade III and ENoG of 60% was observed.