A patient has immediate complete facial paralysis after temporal-bone trauma. CT suggests fallopian-canal disruption and the cornea is exposed. What is the best management principle?
Immediate complete traumatic palsy with possible bony disruption requires time-sensitive expert assessment. Eye protection must start at once while decisions about electrophysiology, imaging and possible surgery are made.
A. Treat as idiopathic Bell palsy alone: Trauma and structural injury demand a different pathway.
B. Wait three months before assessing the nerve: This may miss time-sensitive decision making and neglect eye care.
C. Institute immediate corneal protection and obtain urgent specialist facial-nerve assessment: Immediate complete traumatic palsy with possible bony disruption requires time-sensitive expert assessment. Eye protection must start at once while decisions about electrophysiology, imaging and possible surgery are made.
D. Decompress every traumatic palsy immediately: Management depends on onset, completeness, degeneration, imaging and the patient’s other injuries.
E. Ignore eye protection until testing is complete: Corneal injury can occur during diagnostic refinement.
If weakness were delayed, incomplete and improving with no canal disruption, conservative management would be more likely.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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