Traumatic facial nerve palsy: evaluation and surgical management


  • Chaitry K. Shah Department of Otorhinolaryngology, B. J Medical College, Ahmedabad, Gujarat, India
  • Shalu Gupta Department of Otorhinolaryngology, B. J Medical College, Ahmedabad, Gujarat, India
  • Bela J. Prajapati Department of Otorhinolaryngology, B. J Medical College, Ahmedabad, Gujarat, India
  • Devang P. Gupta Department of Otorhinolaryngology, B. J Medical College, Ahmedabad, Gujarat, India
  • Viral Prajapati Department of Otorhinolaryngology, B. J Medical College, Ahmedabad, Gujarat, India



Trauma, Facial paralysis, Surgical decompression


Background: Acute facial paralysis can result from various causes, among which intra temporal facial palsy is relatively common. Of all the cranial nerves, the facial nerve is most susceptible to injury due to its long course within the skull. Diagnosis of facial palsy is usually made by a good clinical history, examination and radiological investigations. Electrophysiological tests are important for prognosis and optimal time for surgery. The aim is to study the evaluation and surgical management in traumatic cause of facial nerve palsy.

Methods: This prospective cross-sectional study was carried out in 50 patients presented with facial nerve palsy due to trauma in civil hospital Ahmedabad over a period of 1 year from May 2018 to 2019. Patients were examined and graded using House and Brackmann grading system. All the patients were evaluated and treated by surgical decompression. Follow up was carried out upto 6 months.  

Results: The cause of facial nerve palsy in all 50 patients was accidental head trauma. All the patients were managed by surgical decompression. 46 out of 50 patients managed surgically had good recovery with restoration of complete facial nerve function. 4 out 50 patients had poor recovery due to late presentation.  

Conclusions: Early initiation of treatment is important for favorable recovery of facial nerve function after trauma. Surgical treatment is indicated in suspected bony impingement of nerve. Surgical decompression if done early usually results in very good recovery.  


Turel, Keki E. Post traumatic facial paralysis treatment options and strategies. Indian J Neurotrauma. 2005;2(1):33-4.

Dulak, Dominika, Naqvi IA. Neuroanatomy, Cranial Nerve 7 (Facial). Stat Pearls Publishing; 2018.

Ghorayeb, Bechara Y, Yeakley JW. Temporal bone fractures: longitudinal or oblique? The case for oblique temporal bone fractures. Laryngoscope. 1992;102(2):129-34.

Kahinga, Aloyce A, Han JH, Moon S. Total transcanal endoscopic facial nerve decompression for traumatic facial nerve palsy. Yonsei Med J. 2018;59(3):457-60.

Yetiser, Sertac. Total facial nerve decompression for severe traumatic facial nerve paralysis: a review of 10 cases. Int J otolaryngology. 2012; 2011.

Yen TL, Driscoll CL, Lalwani AK. Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function. Otol Neurotol. 2003;24(1):118-22.

Gordin, Eli. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofacial Trauma Reconstruction. 2015;8(1):1-13.

Yadav, Sanjeev. Surgery for post-traumatic facial paralysis: are we overdoing it. European Archives Oto-Rhino-Laryngology. 2018;275(11):2695-703.

Xu, Peng. Surgical timing for facial paralysis after temporal bone trauma. Am J otolaryngology. 2017;38(3):269-71.

Puvanendran K, Vitharana M, Wong PK. Delayed facial palsy after head injury. J Neurology, Neurosurgery Psychiatry. 1977;40(4):342-50.

Patnaik, Uma, Upreti G, Nilakantan A. Surgical management of traumatic intratemporal facial nerve paralysis: Looks matter. Indian J Otology. 2019;25(1):11.

Robinson, Lawrence R. Traumatic injury to peripheral nerves. Muscle Nerve: Official J Am Association Electrodiagnostic Med. 2000;23(6):863-73.

Esslen E. Electrodiagnosis of facial palsy. In: Surgery of the Facial Nerve. Miehlke A, ed. Philadelphia: WB Saunders; 1973: 45-51.

Fisch U. Total facial nerve decompression and electroneuronography. Neurological Surg. 1977:21-33.

Chang CY, Cass SP. Management of facial nerve injury due to temporal bone trauma. Am J otology. 1999;20(1):96-114.

Hato, Naohito. Facial nerve decompression surgery in patients with temporal bone trauma: analysis of 66 cases. J Trauma Acute Care Surg. 2011;71.6:1789-93.

Lieberherr U, Schwarzenbach D, Fisch U. Management of severe facial nerve paralysis in the temporal bone: a review of 82 cases. Proceedings of the Sixth International Symposium on the facial nerve. Amsterdam: Kugler Ghedini Publications; 1990.






Original Research Articles