Facial and vestibulocochlear nerve avulsion at the fundus of the internal auditory canal in a child without a temporal bone fracture.
OBJECTIVE
To describe a case of facial, vestibular, and cochlear nerve avulsion secondary to blunt trauma without an associated temporal bone fracture.


METHODS
Clinical capsule report.


METHODS
University hospital.


METHODS
A 3.5-year-old girl presented with immediate facial nerve paralysis and complete deafness after being struck by an automobile. High-resolution computed tomography demonstrated a depressed occipital bone fracture with no visible fracture of the temporal bone. Magnetic resonance imaging sequence raised the question of VIIth nerve bundle discontinuity at the distal end of the internal auditory canal.


METHODS
The patient underwent a posterior fossa craniotomy via a translabyrinthine approach 9 months after the initial injury, and facial and auditory nerve avulsion at the fundus was confirmed at the time of surgery. The proximal segment of the facial nerve had formed a traumatic neuroma, which was resected, and primarily anastomosed to the rerouted distal segment.


METHODS
Facial nerve function.


RESULTS
Patient has regained facial function to Grade III/VI House-Brackmann with no asymmetry at rest.


CONCLUSIONS
An unusual pattern of injury is described. We suggest that in patients presenting with facial nerve paralysis secondary to blunt trauma, without an associated temporal bone fracture, high-resolution magnetic resonance imaging is recommended to evaluate internal auditory canal discontinuity of the VIIth and VIIIth nerve complexes. A potential mechanism of avulsion is explained.
Corrales
C Eduardo
CE
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California 94305, USA.
Monfared
Ashkan
A
Jackler
Robert K
RK
D000063:Accidents, Traffic; D001299:Audiometry; D002675:Child, Preschool; D003638:Deafness / Q000209:etiology / Q000473:pathology; D007758:Ear, Inner / Q000473:pathology*; D005154:Facial Nerve / Q000473:pathology*; D005155:Facial Nerve Diseases / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D013506:Otologic Surgical Procedures; D013701:Temporal Bone / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D000159:Vestibulocochlear Nerve / Q000473:pathology*; D061285:Vestibulocochlear Nerve Injuries