A sharp temple laceration causes immediate inability to elevate the ipsilateral brow. The injury is seen within hours. What is the best principle?
Immediate focal weakness after a sharp wound implies transection. Early identification and tension-free repair offer the best chance of recovery; distal branches near the medial face may have redundancy, but the temple branch is functionally important.
A. Wait twelve months before assessing the wound: The repair opportunity and identifiable nerve ends may be lost.
B. Early exploration and microsurgical repair of the injured facial branch when feasible: Immediate focal weakness after a sharp wound implies transection. Early identification and tension-free repair offer the best chance of recovery; distal branches near the medial face may have redundancy, but the temple branch is functionally important.
C. Inject botulinum toxin into the weak side: This cannot restore a divided nerve.
D. Perform permanent brow lift alone immediately: Static correction does not replace primary nerve repair when feasible.
E. Close skin without documenting function: Baseline branch examination and informed planning are essential.
If weakness developed days after a blunt injury with nerve continuity likely, observation and serial grading could be appropriate.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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