Penetrating Temporal Bone Trauma

The management of patients who have facial paralysis after penetrating trauma to the temporal bone is more straightforward than in closed-head trauma. The timing of the paralysis is usually immediate onset, and the location of the injury can be evaluated with CT scan. Surgery is recommended to patients who have CT evidence of penetrating trauma on their temporal bone through the facial nerve and electrical evidence of degeneration. If the CT scan does not indicate a direct penetrating injury to the facial nerve, but electrical degeneration reaches less than 10% function, these patients are also offered surgery, unlike the closed-head trauma patients, because heat or associated trauma from a missile injury may be responsible for delayed paralysis.13 (Table 42-3).

s Surgery s Observe

TABLE 42-1

Closed-Head Trauma Paralysis: 3-Week Decision Algorithm

CT"

Electrical Testing4

Therapy

TABLE 42-1

Closed-Head Trauma Paralysis: 3-Week Decision Algorithm

CT"

Electrical Testing4

Therapy

+

s

Observe

+

+

s

Surgery

s

Observe

+

s

Observe'

a CT +, 1-mm diastasis along course of facial nerve, or spicule in nerve.

b Electrical testing +, < 10% residual function on electroneuronography.

a CT +, 1-mm diastasis along course of facial nerve, or spicule in nerve.

b Electrical testing +, < 10% residual function on electroneuronography.

e Patients are informed that some anecdotal evidence supports facial nerve exploration and decompression. However, I encourage these patients to await the 6-month point.

TABLE 42-3

Management of Patients Who Have Facial Paralysis from Penetrating Trauma

TABLE 42-3

Management of Patients Who Have Facial Paralysis from Penetrating Trauma

CTa

Electrical Testing4

Therapy

+

s

Observe

+

+

s

Surgery

s

Observe

+

s

Surgery

a CT +, 1-mm diastasis along course of facial nerve, or spicule in nerve. bElectrical testing +, < 10% residual function on electroneuronography.

a CT +, 1-mm diastasis along course of facial nerve, or spicule in nerve. bElectrical testing +, < 10% residual function on electroneuronography.

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