Managing Temporal Bone Fractures in Patients When the Facial Nerve Cannot Be Examined

Skull base fractures typically are caused by high-impact injuries that may also result in intracranial damage and delayed assessment of facial nerve paresis. In a retrospective study of 590 patients treated between March 2019 and October 2023, researchers in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston found that facial nerve paresis is more likely to occur in patients with temporal bone fractures who cannot undergo an immediate facial nerve examination.

“We discovered a gap in knowledge about the natural course of patients with temporal bone fractures whose facial nerve response can’t be examined immediately after injury, either because they’re intubated or have neurological damage,” says Vivian Kaul, MD, chief of otology, neurotology, and lateral skull base in the department and senior author of the study. “We hypothesized that these patients are likely to have more severe fractures with an increased rate of facial nerve paresis, and our retrospective study found this to be true.”

“In these cases, prophylactic steroid therapy should be considered to prevent a delay in treatment, particularly in the presence of ossicular discontinuity, carotid canal fractures, or vascular injury – findings associated with an increased risk of facial nerve paralysis,” she observes.

Dr. Kaul presented the results of the study at the meeting of the American Neurotology Society held at the Combined Otolaryngology Spring Meetings (COSM) in New Orleans in May.

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