Not-Bell's palsy

Question: A 4 year old female experiences a severe head trauma after falling from the top bunk of bunk beds. In the emergency department it is noted that the child is not moving the right side of her face. Examination reveals House-Brackmann grade 6 facial function on the right side. The facial nerve appears to be in continuity on the scan but there is a fracture line through the proximal tympanic segment. Weber test lateralizes to the right ear. Which of the following is statements is most accurate?

a) Outcomes following conservative management of pediatric temporal bone fractures that involve the facial nerve are better than those in adults.

b) ENoG should be done within 24 hours for the best assessment of facial nerve integrity

c) The facial nerve should be decompressed using a translabyrinthine approach as middle fossa surgery is contraindicated in children

d) None of the above

[Answer will be posted with next week's new question]

Answer to last week's question, “Side to Side” (April 24, 2023)

D - As central auditory pathways are likely developed, implantation will likely result in open-set speech understanding in the implanted ear.