即発性外傷性顔面神経麻痺例 A Case of Immediate Type Traumatic Facial Nerve Palsy
Accurate diagnosis of early stage traumatic facial palsy is often difficult due to severe complications. In this paper, a case of traumatic facial palsy in a 5-year old male is presented. Left facial palsy was noticed following a head injury. As the facial palsy gradually progressed after the trauma, he was referred to our clinic, 3 days after the onset of palsy. Facial movement was evaluated based on the 40-point grading system. He showed 8/40 points, but a CT scan didn't depict any temporal bone fracture which might involve the facial canal. In spite of concentrative treatment, his facial movement score deteriorated to 4/40 points 5 days after the trauma. We performed decompression surgery 5 days after the onset of palsy. Bony fragment from a fracture involving the tympanic segment of the facial nerve impinged directly on the nerve. In this case, surgical exploration revealed a fracture which extended to the tympanic portion.<br>He had a good recovery of facial movement with a score of 32/40 points 8 months after surgery. This case shows that temporal bone fractures are not always revealed by CT and that early decompression of the facial nerve is recommended when facial palsy gradually gets worse following trauma.
耳鼻咽喉科臨床 95(2), 135-138, 2002-02-01