PMC9990793_01
Preoperative CT showed left frontal epidural hematoma and temporal bone fracture (white arrow). The yellow, open white, and gray arrows indicate the internal auditory canal, cochlear, and lateral semicircular canal, respectively.
SNI-14-47-g001.jpg
PMC9990793_01_SNI-14-47-g001.jpg
F1
The petrous bone fracture was a mixed pattern [Figure 1].
The temporal bone fracture was confirmed when the left suboccipital hematoma was removed (white arrow).
SNI-14-47-g002.jpg
PMC9990793_01_SNI-14-47-g002.jpg
F2
Left facial nerve damage was also suspected due to a mixed longitudinal and horizontal petrous bone fracture [Figure 2].
Follow-up at 6 months postoperative showing recovery of both orbicularis oris function and lower lip depressors. (a and b) before reconstruction surgery.
SNI-14-47-g003.jpg
PMC9990793_01_SNI-14-47-g003.jpg
F3
However, facial nerve palsy did not improve and remained stable with an H-B grade VI [Figures 3a and b].
Intraoperative image of the facial nerve decompressed in the mastoid (yellow arrow) and tympanic (open white arrow) segments; (left ear, mastoidectomy, and posterior tympanotomy were performed, luxated incus and head of the malleus were removed). White arrows point to the fracture line. The gray arrow indicates a granulated injured facial nerve in (a) and replaced by a greater auricular nerve in (c). Normal facial nerve was confirmed by translabyrinthine approach (b). (d) A schematic image of recontraction surgery.
SNI-14-47-g004.jpg
PMC9990793_01_SNI-14-47-g004.jpg
F4
After dissecting the facial nerve, a greater auricular nerve graft was harvested, and the facial nerve was reconstructed using the greater auricular nerve as an interposition graft [Figure 4].
Follow-up at 6 months postoperative showing recovery of both orbicularis oris function and lower lip depressors. (a and b) after reconstruction surgery.
SNI-14-47-g005.jpg
PMC9990793_01_SNI-14-47-g005.jpg
F5
Functional recovery was confirmed mainly in the left orbicularis oris muscle about half-year after the reconstruction surgery (House and Brackman grade 4) [Figures 5a and b].