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Facial diplegia and deafness following a fall
International Journal of Emergency Medicine volume 3, pages 475–476 (2010)
A 45-year-old man presented to the emergency department (ED) after falling down two flights of stairs. He had bilateral raccoon eyes, subconjunctival haemorrhages and CSF otorrhoea suggestive of skull base fracture (SBF). Although he had difficulty speaking and responded inappropriately, giving the impression of mixed dysphasia, written communication was normal, and he complained of deafness and dizziness.
Facial motion was barely perceptible and complete eye closure was not possible, consistent with grade 5 facial palsies on the House-Brackmann facial nerve grading system. Bell’s phenomena (Fig. 1) and dysarthrophonia secondary to facial weakness were marked. He was also mildly ataxic. Computed tomography (CT) imaging confirmed extensive SBF and audiometric testing confirmed bilateral deafness. High-resolution axial petrous temporal bone CT (Fig. 2) demonstrated fractures involving the facial canals. The right-sided fracture traversed the fundus of the internal auditory canal, likely transecting the cochlear nerve, and the left-sided fracture involved the otic capsule, likely disrupting auditory and vestibular function.
Post-traumatic facial nerve palsy complicates 1.5% of SBFs involving the temporal bones . Petrous temporal bone fractures may disrupt the facial nerve, membranous labyrinth and inner ear. While cranial nerves seven and eight may be injured by petrous temporal bone fractures, concomitant bilateral facial weakness and deafness in this setting is extremely rare . Most post-traumatic facial nerve injuries recover with conservative management and time [3, 4].
This case illustrates how bilateral facial weakness and deafness may be mistaken for mixed dysphasia and highlights the need to consider it in patients with apparent speech disturbances in the ED.
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Saidha, S., Fanning, N. & Counihan, T.J. Facial diplegia and deafness following a fall. Int J Emerg Med 3, 475–476 (2010). https://doi.org/10.1007/s12245-010-0163-2
- Facial Nerve
- Internal Auditory Canal
- Facial Canal
- Membranous Labyrinth
- Skull Base Fracture