Delayed Bilateral Facial Nerve Palsy Manifesting 3 Months after Traumatic Brain Injury: A Case Report

Abstract

Facial nerve palsy (FNP) can be a challenging medical condition, and bilateral FNP is an uncommon occurrence that is potentially fatal and warrants urgent medical intervention. We report a rare case of bilateral FNP that developed after traumatic brain injury (TBI), which we approached through an electromyographic study. A 23-year-old male patient had experienced a fall-down injury from height of 4 meters while on his military service. Computed tomography of the brain and facial bone showed acute TBI and multiple skull base fractures. Limited facial expression and dysarthria started at the time of cranioplasty, which was about 3 months after the patient’s initial presentation, and these symptoms gradually deteriorated over time. An electrodiagnostic study demonstrated incomplete bilateral facial nerve lesions, which were strongly indicated as lower motor neuron lesions. An early diagnosis based on electrodiagnostic study should be considered for proper treatment, which can achieve optimal functional recovery after bilateral FNP.