MINORS MANUAL
Facial nerve injury commonly occurs in facial trauma, especially those affecting the preauricular region, where the nerve branches. This injury can result in partial or complete paralysis of the facial muscles on the affected side, impacting facial expressions, the ability to close the eye, and other motor functions of the face.
Diagnosis
Diagnosis is based on clinical evaluation, observing facial asymmetry, inability to move the facial muscles on the affected side (such as raising the eyebrow, closing the eye, smiling), and loss of motor control in the lips and cheeks. The history of trauma or previous surgery in the region should be assessed. Tests like electromyography (EMG) or magnetic resonance imaging (MRI) may be used to determine the extent of the damage.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Bell’s palsy | Sudden facial paralysis, no prior trauma, idiopathic origin |
Temporal bone fracture | Facial asymmetry, hearing loss, vertigo following trauma |
Facial neuritis | Pain, progressive weakness without traumatic history |
Cerebellopontine angle tumour | Hearing loss, vertigo, gradual facial paralysis |
Emergency Management
Detailed neurological assessment: Document the function of all branches of the facial nerve, observing the mobility of facial muscles.
Protect the eye: If the patient cannot close the eye, it is crucial to protect the cornea with lubricants or an eye patch to prevent corneal injury due to exposure.
Pain management: Provide adequate analgesia in cases of significant trauma.
Diagnostic imaging: Request imaging studies such as CT or MRI if a skull fracture or severe facial nerve damage is suspected.
Referral to specialist: In cases of complete paralysis or severe trauma, the patient should be referred to a plastic surgeon or neurosurgeon.
Definitive Treatment
Treatment depends on the severity of the injury. Partial damage may show spontaneous improvement over weeks or months. Complete injuries may require surgical intervention for nerve repair or grafting. Rehabilitation with facial physiotherapy is essential to optimise functional recovery.
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