“A Case Report of Gun Shot Injury to the Stylomastoid Foramen: How Otolaryngologists Are Uniquely Trained to Manage Facial Nerve Injury”
Jeffrey Yu, Alex Labby, Kevin Lee
Background: Facial nerve injury due to a gunshot wound at the level of the stylomastoid foramen is a rare but extremely devastating injury. To appropriately manage this case, a surgeon requires training in management of the mastoid segment of the facial nerve, and the extratemporal facial nerve. In this case, a patient was referred to a tertiary care center after a self-inflicted gunshot wound to the skull base on the right. On examination, the patient was noted to have right sided injury to cranial nerve VII, X, and XI.
Study Design: Case report
Intervention: After appropriate radiological imaging and stabilization, the patient underwent exploration and facial nerve repair. Surgical procedures to identify the proximal segment included a mastoidectomy, and decompression and mobilization of the vertical section of the facial nerve out of the stylomastoid foramen. Identification of the distal segment required a retrograde approach from the marginal mandibular branch of the facial and superficial parotidectomy. Facial nerve repair was performed using a great auricular cable nerve graft using microsurgical technique. In addition, the patient had direct laryngoscopy for vocal cord injection.
Results: The patient had immediate post-operative voice improvement and is being followed for facial nerve regeneration.
Discussion: Though a residency with diverse educational exposure, otolaryngologists gain expertise with the extemporal facial nerve via practice with parotidectomy and neck dissection. Similarly, otolaryngologists gain expertise with the mastoid segment of the facial nerve by participating in surgery in cochlear implantation, and mastoidectomy for chronic ear surgery. Microsurgical repair is learned during head and neck reconstruction. General otolaryngologists, upon graduating, are in a unique position to integrate these skills from different specialty domains such that they can provide comprehensive surgical treatment of these rare and challenging cases of facial nerve trauma.
- Present a case of facial nerve injury related to a gunshot wound to the stylomastoid foramen and the multiple surgical procedures required to perform a facial nerve repair.
- Discuss how comprehensive training in otolaryngology uniquely positions general otolaryngologist to manage trauma of the facial nerve.
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Corresponding Author: Dr. Jeffrey Yu
Senior Author: Dr. Jeffrey Yu
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