Delayed Lower Motor Neurone Facial Nerve Palsy Following a Traumatic Head Injury

Delayed facial nerve weakness secondary to head injury is rare. The mechanism of immediate facial nerve paralysis is obvious, however, the delayed presentation remains disputed. We report a 58-year-old gentleman who presents 6 days after being discharged following head trauma with a 2-day history of facial nerve paralysis (House-Brackmann grade 6). Computed tomography (CT) head showed a minimally displaced longitudinal squamous temporal bone fracture initially with nerve conduction studies and electromyograpy revealing a relative reduction in left facial motor amplitudes with moderate recruitment. He showed good progress following high-dose steroids and conservative management. Early involvement of ear, nose and throat (ENT) surgeons is crucial. The use of both high-resolution CT scanning and nerve conduction studies will help guide management as early as possible and improve outcomes in these patients.