Post-traumatic Bilateral Facial Paralysis

Bilateral facial paralysis is a rare clinical entity. It is also diagnostic challenge which, unlike unilateral facial paralysis, it is can be difficult to recognize because of a lack of facial asymmetry. A 22 year-old man referred for neurological evaluation because of bilateral facial paralysis (House-Brackmann grade V). He has initially presented unconsciousness after he sustained closed head injury after a motor vehicle accident. Initial computed tomography (CT) scans revealed a small epidural hematoma, right temporal bone fracture and air densities around the basal cistern. On the 10 hospital day, he was noted to have incomplete closure of both eyes and a feeding difficulty with drooling. Electrodiagnostic testing confirmed the diagnosis of bilateral facial paralysis. The high-resolution CT scans showed bilateral temporal bone fractures with no facial canal involvement. There was no surgical intervention based on delayed onset of facial paralysis and the findings of the high-resolution CT scans. He recovered incompletely on post-injury 7 month without treatment. we report a rare case of post-traumatic bilateral facial paralysis with literature review.