title: Mastoid bone fracture presenting as unusual delayed onset of facial nerve palsy.
abstract: Delayed-onset facial nerve paralysis is a rather uncommon complication of a mastoid bone fracture for children younger than 10 years. We routinely arrange a cranial computed tomography (CT) for patients encountering initial loss of consciousness, severe headache, intractable vomiting, and/or any neurologic deficit arising from trauma to the head. However, minor symptomatic cranial nerve damage may be missed and the presenting symptom diagnosed as being a peripheral nerve problem. Herein, we report a case of a young boy who presented at our emergency department (ED) 3 days subsequent to his accident, complaining of hearing loss in the right ear and paralysis of the ipsilateral face. Unpredictably, we observed his cranial CT scan revealing a linear fracture of the skull over the right temporal bone involving the right mastoid air cells. The patient was treated conservatively and recovered well without any adverse neurologic consequences. We emphasize that ED physicians should arrange a cranial CT scan for a head-injured child with symptomatic facial nerve palsy, even if there are no symptoms such as severe headache, vomiting, Battle sign, and/or initial loss of consciousness.
authors: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei Neihu 114, Taiwan.
authors: Ko-Chiang
authors: KC
authors: Hsu
authors: Ann-Ching
authors: AC
authors: Wang
authors: Shyi-Jou
authors: SJ
authors: Chen
mesh_terms: D000058:Accidental Falls; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002648:Child; D005158:Facial Paralysis / Q000188:drug therapy / Q000209:etiology*; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008416:Mastoid / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones