Article
Therapy and follow-up in a gunshot victim with facial nerve injury
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Authors
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Ellen Kostka
- HNO, Jena, Germany
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Claus Wittekindt
- HNO, Jena, Germany
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Sven Koscielny
- HNO, Jena, Germany
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Orlando Guntinas-Lichius
- HNO, Jena, Germany
| Published: | August 8, 2007 |
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Outline
Text
Introduction: We present a case report of a 23 year-old female patient with a gunshot wound of the temporal bone and immediate onset facial nerve injury. Indications for surgery, surgical strategies, surgical timing, and postoperative therapy, respectively, are discussed.
Case report: The young woman was the victim of a shot in her head by close range by her deserted boyfriend. She was found with retained consciousness and a bullet wound of the mastoid bone besides complete peripheral facial nerve palsy on the right side.
Method/Results: The patient was intubated, narcotized and transported to our Department immediately after the assault. The bullet was detected by X-ray and than excised from the oropharynx, followed by surgical exploration of the facial nerve and the facial nerve fan after mastoidectomy and parotidectomy. The facial nerve was completely transected in its mastoidal segment. Because of a large gap between the nerve stumps, we used a interpositional graft with greater auricular nerve for restoration of the nerve continuity.
The postoperative course was uneventful. She started with proprioceptive facial nerve training, short-time massage like knocking/twitching/palming the face, lips-wobbling, blowing-up a balloon, pressing the tongue against the inner side of the cheek when mouth is closed four days after surgery. The eye was protected by passager external lidloading and panthenol ointment by day and by wet dressing over night. The House-Brackmann-Index improved from 6 to 5-4, the Stennert-Index from 10 to 8-7 in 8 months after surgery.
Discussion: Surgical exploration of the facial nerve should be performed as soon as possible after traumatic injury and complete paresis, since delayed repair may decrease the chance for optimal facial rehabilitation. Above-named surgical intervention is the recommended surgical technique for immediate facial nerve repair in case of multi-slice mastoid fracture.
Facial nerve injury by a bullet in proximity to the stylomastoid foramen is most common region for such a lesion. The area must be explored carefully. In the majority of cases, cable grafting with the greater auricular nerve is mandatory, because often the distance of the nerve ends itself is too large for rerouting and end-to-end suture.
