Bilateral Post-Traumatic Facial Palsy: A Case Report and Literature Review

INTRODUCTION: Bilateral facial nerve (FN) palsy due to temporal bone fracture is a rare clinical entity, with few cases reported. The choice between conservative and surgical treatment is more complex than in unilateral cases. MATERIALS AND METHODS: A thorough search of the available literature on trauma-related bilateral FN palsy revealed 22 reports. Our own experience is also described. RESULTS: All bilateral delayed- and unknown-onset cases were treated conservatively, with a good recovery rate (70.5%). Surgery was performed on 6 sides within the immediate-onset group, with a good recovery rate (83.3%). CONCLUSIONS: In the management of traumatic FN palsy, the main controversial issue focusses on indications for surgery as well as timing and type of approach. In bilateral cases, it is more challenging to make the right choice, due to lack of facial asymmetry and/or state of unconsciousness following severe trauma. Electro-diagnostic tests and high-resolution computed tomography are essential for decision-making.