Acute traumatic extratemporal facial nerve injury: A 5-year review

Abstract

Background

Traumatic facial nerve injury is the second leading cause of facial paralysis, presenting significant challenges such as difficulties with eating, speaking, impaired vision, and loss of facial expression. Understanding these injuries is critical for plastic surgeons to optimize recovery and functional outcomes. This study examined our experience with acute traumatic extratemporal facial nerve injuries, focusing on their characteristics, the frequency of affected nerve branches, and identification using Seckel’s facial danger zones as anatomical landmarks. We also explored the implications of surgical management based on the current literature and our experience.

Methods

We reviewed 50 patients with acute traumatic extratemporal facial nerve injuries treated at Hospital General Dr. Manuel Gea González in Mexico City from January 2019 to January 2024. The collected data included demographics (age, sex, severity, and time to medical attention), injury mechanism, affected nerve branches using Seckel’s zones, and treatment methods.

Results

The majority of the patients were male (82%), with an average age of 29 ​± ​16 years. Sharp trauma from assault was the most common cause (66%). The buccal and frontal branches were most frequently affected, with Seckel zones IV and II involved in 46.86% and 33.33% of cases, respectively. Primary neurorrhaphy was performed in 96% of the patients.

Conclusion

The effective management of traumatic facial nerve injuries relies on understanding the characteristics of the injury and using anatomical landmarks for prompt localization. Primary neurorrhaphy is the preferred surgical approach, with nerve grafting being an alternative. Ideally, early intervention within 72 h is crucial for optimal nerve recovery.