Delayed Post-traumatic Bilateral Facial Nerve Paralysis: A Case Report

Bilateral facial nerve palsy is a rare complication of craniofacial trauma, particularly following temporal bone fractures.Its delayed onset may complicate early recognition, especially when facial movements are initially preserved.Clinical progression, fracture characteristics, and electrophysiological findings are important considerations in diagnostic assessment and management.We report the case of a man in his early 40s who sustained cranioencephalic and thoracoabdominal trauma following a fall from approximately 5 m.Computed tomography revealed bilateral temporal bone fractures, including a transverse fracture involving the left perigeniculate region and a longitudinal fracture involving the right mastoid segment of the facial nerve canal, together with additional facial fractures.Facial movements were initially preserved.On the fourth day after trauma, the patient developed left-sided peripheral facial weakness, followed by contralateral involvement within hours, progressing to severe bilateral facial nerve palsy (House-Brackmann grade V) by the fifth day.Early electroneurography demonstrated markedly reduced left-sided motor responses compared with relatively preserved right-sided responses, although the examination preceded the development of clinically evident right-sided paralysis.Audiological assessment revealed asymmetric bilateral hearing loss, more pronounced on the left.Conservative management included systemic corticosteroids, ocular protection, and facial physiotherapy.No significant improvement in facial function was observed at discharge on day 10.At one month, rightsided facial function had recovered completely, while partial improvement was observed on the left.At the final seven-month follow-up, only mild residual left-sided weakness remained (House-Brackmann grade II).This case illustrates the importance of serial clinical assessment in patients with temporal bone fractures, as facial nerve palsy may develop despite initially preserved facial movements.It also highlights the limitations of early electrophysiological findings in predicting long-term functional recovery.Although substantial improvement was observed following conservative management, the contributions of treatment and spontaneous nerve recovery cannot be distinguished in a single case.Therapeutic decisions should therefore be individualized according to clinical progression, imaging findings, and the patient's overall condition.