TRAUMA TIC FACIAL NERVE PARALYSIS 1. FRACTURES OF TEMPORAL BONE Fractures of temporal bone may be longitudinal, transverse or mixed. Facial palsy is seen more often in transverse fractures (50%). Paralysis is due to intraneural haematoma, compression by a bony spicule or transection of nerve. In these cases, it is impoant to know whether paralysis was of immediate or delayed onset. Delayed onset paralysis is treated conservatively like Bell palsy while immediate onset paralysis may require surgery in the form of decompression, re-anastomosis of cut ends or cable nerve graft. 2. EAR OR MASTOID SURGERY Facial nerve is injured during stapedectomy, tympanoplasty or mastoid surgery. Paralysis may be immediate or delayed and treatment is the same as in temporal bone trauma. Sometimes, nerve is paralyzed due to pressure of packing on the exposed nerve and this should be relieved first. Operative injuries to facial nerve can be avoided if attention is paid to the following: (a) Anatomical knowledge of the course of facial nerve, possible variations and anomalies and its surgical landmarks. Cadaver dissections should be an impoant pa of the training in ear surgery. (b) Always working along the course of nerve and never across it. (c) Constant irrigation when drilling to avoid thermal injury. Use diamond burr when working near the nerve. (d) Gentle handling of the nerve when it is exposed, avoiding any pressure of instruments on the nerve. (e) Not to remove any granulations that penetrate the nerve. (f) Using magnification; never to work on facial nerve without an operating microscope. 3. PAROTID SURGERY AND TRAUMA TO FACE Facial nerve may be injured in surgery of parotid tumours or deliberately excised in malignant tumours. Accidental injuries in the parotid region can also cause facial paralysis. Application of obstetrical forceps may also result in facial paralysis in the neonate due to pressure on the extratemporal pa of nerve. Ref : ENT textbook by Dhingra 6th edition Pgno : 96,97