Traumatic Facial Nerve Palsy: A Case of Delayed-Onset High-Grade Paralysis Managed with Surgical Decompression

Traumatic facial nerve paralysis (FNP) accounts for approximately 17% of all peripheral FNP cases and is frequently observed in temporal bone fractures. Its management is still controversial and remains a subject of debate, particularly concerning the optimal timing of surgical intervention. We report a case of a 24-year-old male who developed delayed onset right-sided FNP (House-Brackmann Grade V) following a road traffic accident, On referral to our centre, electrodiagnostic studies demonstrated severe nerve degeneration. Despite adequate conservative management, there was no clinical improvement. Consequently, facial nerve decompression was undertaken as an individualised clinical decision. Postoperatively, the patient demonstrated marked functional recovery. This case underscores the importance of careful patient selection and individualised decision-making when considering surgical intervention in delayed-onset, severe, and persistent traumatic facial nerve palsy.