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Background: Cranial nerve lesions often accompany head trauma. Olfactory, facial and vestibular nerves are the most commonly injured nerves, but bilateral facial palsy is an extremely rare clinical entity, accounting for about 1.2% of all facial palsies. Trauma, that can often be associated with fractures of the skull base and temporal bones, only rarely causes bilateral facial palsy. Facial electromyography takes at least 72 hours to become abnormal. Abducens nerve injury is observed in 2.7% of patients with head trauma. Abducens palsy, associated with bilateral traumatic facial paralysis, is even rarer.
Case Report: A 59-year-old woman with a history of motor vehicle accident (MVA) is presented. She had bilateral facial and left abducens paralyses. Cranial computerized tomography revealed a bilateral temporal bone fractures, and pneumocephalus. Six days after the trauma bilateral facial electroneuromyography was done and no potential was demonstrated. Facial nerve functions improved with steroid therapy.
Conclusions: Bilateral traumatic facial paralysis is a rare clinical entity and if there is no surgical indication, tends to resolve with a prolonged course of steroids.