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Vol. 24. Num. 5.September - October 2013
Pages 191-236
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Vol. 24. Num. 5.September - October 2013
Pages 191-236
Case report
DOI: 10.1016/j.neucir.2013.01.003
Bilateral traumatic facial paralysis. Case report
Parálisis facial bilateral traumática. A propósito de un caso
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Jose Undabeitiaa,??
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joseundabeitia@hotmail.com

Corresponding author.
, Brian Liub, Courtney Pendletonb, Pere Noguesa, Roberto Noboaa, Jose Ignacio Undabeitiac,d
a Servicio de Neurocirugía, Hospital Universitario Arnau de Vilanova, Lleida, Spain
b Departamento de Neurocirugía, Universidad Johns Hopkins, Baltimore, United States
c Servicio de Otorrinolaringología, Hospital Universitario de Cruces, Barakaldo, Spain
d Departamento de Dermatología, Oftalmología y Otorrinolaringología, Universidad del País Vasco, País Vasco, Spain
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Neurocirugia 2014;25:19810.1016/j.neucir.2014.02.001
José González-Tortosa
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Table 1. Traumatic SBFPs described in literature. [R]: right, [L]: left.
Table 2. Differential diagnosis for acquired bilateral facial palsy.
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Abstract

Although traumatic injury of the facial nerve is a relatively common condition in neurosurgical practice, bilateral lesions related to fracture of temporal bones are seldom seen. We report the case of a 38-year-old patient admitted to Intensive Care Unit after severe head trauma requiring ventilatory support (Glasgow Coma Scale of 7 on admission). A computed tomography (CT) scan confirmed a longitudinal fracture of the right temporal bone and a transversal fracture of the left. After successful weaning from respirator, bilateral facial paralysis was observed.

The possible aetiologies for facial diplegia differ from those of unilateral injury. Due to the lack of facial asymmetry, it can be easily missed in critically ill patients, and both the high resolution CT scan and electromyographic studies can be helpful for correct diagnosis.

Keywords:
Bilateral facial paralysis
Skull base fracture
Facial nerve injuries
Resumen

Aunque el déficit de origen traumático del séptimo par craneal es una entidad común en la práctica neuroquirúrgica, la parálisis facial bilateral asociada a fracturas temporales supone un episodio infrecuente. Describimos el caso de un paciente de 38años que sufre un traumatismo craneoencefálico severo (Glasgow Coma Scale de 7). En la TC inicial se apreció una fractura de peñasco longitudinal derecha y transversal izquierda. El paciente ingresó en la unidad de cuidados intensivos y, tras la extubación, se comprobó la existencia de una diplejía facial bilateral.

El déficit bilateral del séptimo par craneal posee una etiología distinta al déficit unilateral. En estos casos, la ausencia de asimetría facial puede dificultar el diagnóstico, por lo que la TC de alta resolución y el estudio electromiográfico son útiles para su detección.

Palabras clave:
Parálisis facial bilateral
Fractura de base de cráneo
Lesión del nervio facial

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