Post-traumatic extratemporal facial nerve paralysis following a cervical stab wound: a case report

Background Extratemporal facial nerve injuries caused by penetrating cervical trauma are uncommon and often underestimated due to minimal external lesions. Early recognition and prompt management are essential to optimize functional recovery. Case Presentation We report the case of a 17-year-old male admitted for a left retroauricular stab wound. The initial evaluation revealed no major vascular or osseous injuries. Upon further examination, a complete immediate peripheral facial paralysis (House–Brackmann grade VI) was identified. Temporal bone Computed Tomography (CT) imaging was performed to evaluate the intertemporal portion of the facial nerve. Given the immediate onset of paralysis, urgent surgical exploration was undertaken without prior electrodiagnostic testing, in accordance with current recommendations suggesting early repair when transection is suspected. Intraoperatively, the proximal and distal segments of the facial nerve were identified at the stylomastoid foramen and within the upper cervical region, respectively, and were repaired by end-to-end micro suturing. Postoperative management included corticosteroid therapy, vitamin supplementation, ocular protection, and early physiotherapy. At 3-month follow-up, the patient showed partial recovery (House–Brackmann grade III), consistent with published outcomes following timely nerve repair. Conclusion This case highlights the importance of careful clinical assessment in penetrating cervical trauma, even when wounds appear minor. Immediate complete facial paralysis strongly suggests nerve transection and warrants early surgical intervention. Prompt management can result in favorable outcomes.