Clinical Evaluation and Management of Facial Nerve Trauma

1. CLINICAL EVALUATION AND
MANAGEMENT OF FACIAL
NERVE TRAUMA
Ade Wijaya, MD – May 2023

2. INTRODUCTION
 20 in 100.000  facial palsy
 16 % of which  traumatic; temporal bone fracture
 More distal the injury, the purer the motor deficits and
lesser the sensory and parasympathetic deficits
Jackson CG, von Doersten PG. The facial nerve: Current trends in diagnosis, treatment, and rehabilitation. Med Clin North Am. 1999;83:179–195, x.
May M. Trauma to the facial nerve. Otolaryngol Clin North Am. 1983;16:661–670.
Baumann BM, Jarecki J. Posttraumatic delayed facial nerve palsy. Am J Emerg Med. 2008;26:115.e111–115.e112.

3. ANATOMY

4. CLINCAL EVALUATION
Duration
Mechanism
Location
Brown S, Isaacson B, Kutz W, Barnett S, Rozen SM. Facial nerve trauma: clinical evaluation and management strategies. Plastic and reconstructive surgery. 2019 May 1;143(5):1498-
512.

5. DURATION
Acute
• 0-72 hours
Subacute
• 72 hours – (12-18 months)
Longstanding
• > 12-18 months
Brown S, Isaacson B, Kutz W, Barnett S, Rozen SM. Facial nerve trauma: clinical evaluation and management strategies. Plastic and reconstructive surgery. 2019 May 1;143(5):1498-
512.

6. ETIOLOGY, MECHANISM, AND PROGNOSIS
 Most intratemporal injuries are caused by blunt
trauma; less commonly, penetrating trauma.
 The mechanism of injury can be facial nerve
compression or, less frequently, laceration.
 Longitudinal temporal bone or otic capsule–sparing
fractures have better prognosis than transverse or
otic capsule–violating fracture
 Sensorineural hearing loss versus conductive
hearing loss indicates poorer prognosis.
Brown S, Isaacson B, Kutz W, Barnett S, Rozen SM. Facial nerve trauma: clinical evaluation and management strategies. Plastic and reconstructive surgery. 2019 May 1;143(5):1498-
512.

7. DIAGNOSTIC EVALUATION
 Computed tomographic
 Magnetic resonance imaging
 Electroneurography and electromyography
Brown S, Isaacson B, Kutz W, Barnett S, Rozen SM. Facial nerve trauma: clinical evaluation and management strategies. Plastic and reconstructive surgery. 2019 May 1;143(5):1498-
512.

8. MANAGEMENT
Conservative vs Surgical
 Corticosteroid, physical therapy
 Facial nerve decompression (scant high-level
evidence regarding the benefits); sooner is better
Brown S, Isaacson B, Kutz W, Barnett S, Rozen SM. Facial nerve trauma: clinical evaluation and management strategies. Plastic and reconstructive surgery. 2019 May 1;143(5):1498-
512.

9. THANK YOU