Two pediatric cases of post-traumatic facial paralysis with delayed onset

Abstract

Posttraumatic facial paralysis with delayed onset generally has a good outcome. This is especially true in pediatric cases in which incomplete paralysis always suggests a favorable prognosis. We describe two children with posttraumatic facial paralysis treated with surgical facial nerve decompression. Both patients had longitudinal, otic capsule-sparing fractures with ossicles displacement. Fracture line reached the vertical segment of facial canal for one case, while enhanced MRI revealed the abnormal signal intensity around geniculate ganglion for the other case. They showed asymmetrical facial movement after recovering from coma, which evoked delayed-onset paralysis. Electroneurography showed more than 90% nerve degeneration, suggesting an unfavorable prognosis in both. However, while one had permanent moderate facial paralysis, the other had complete recovery after surgery. These cases reconfirmed the difficulty of estimating prognosis for post-traumatic pediatric facial paralysis and suggested the earlier examination of ENoG and enhanced MRI, especially in comatose cases.

Keywords

• Post-traumatic facial paralysis
• temporal bone fracture
• MRI
• pediatric
• delayed onset