Trauma

Sudden onset facial palsy is a medical emergency and requires urgent assessment by a physician to rule out potentially life threatening conditions.

Penetrating Trauma

The facial nerve is susceptible to all kinds of trauma. There is blunt trauma, such as hitting one’s head in a car accident or in a fall, or striking the face. In blunt trauma to the skull, if the skull is fractured through the temporal bone (the bone that houses the hearing organs and the facial nerve), then the facial nerve, which courses through this bone, can either be bruised, or even divided or injured by a bony spicule.  There is debate about how to handle facial nerve injury after blunt trauma to the skull, with some data showing that surgery to open up the bony channel and give the facial nerve more room to swell, leads to a better overall result.  Blunt trauma directly to the face can sometimes result in extensive bruising and soft tissue damage which can create facial weakness either by damaging a nerve branch, or damaging one of the muscles of facial expression. Very often, blunt trauma to the face is treated first with observation for spontaneous healing, and any facial weakness that still remains can be managed in a delayed fashion.

 

The other category of trauma involving the facial nerve is called penetrating trauma. This injury type involves the skin being pierced by an object, such as a bullet, a knife, or a piece of glass. Penetrating trauma can cause more lacerations to the nerve and to the facial muscles; most of these injuries should be explored surgically right away, to see if the nerve endings can be identified and surgically repaired. Of course, every single situation is different, and depending upon the location of the penetrating trauma, likelihood of nerve injury changes. The most important consideration in penetrating trauma with facial weakness is to have the appropriate team to explore the facial nerve. The earlier a traumatic wound with facial weakness is explored, the higher the likelihood that surgeons will be able to identify and repair any damage to structures.  One special form of penetrating trauma is inadvertent damage to the facial nerve during a planned surgical procedure. Unintended damage to the facial nerve is called “iatrogenic” injury, meaning “caused by the doctor”. When patients experience iatrogenic injury to the facial nerve, either from Oral and maxillofacial surgery, cosmetic surgery, ear surgery, or other head and neck surgery, the most rational approach is for the surgeon to involve another fresh perspective from a facial nerve expert. That way, consensus can be developed as to the proper management of the facial weakness, and appropriate re-exploration can occur if necessary.

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