The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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Lower facial nerve palsy from mastoid fracture

Photo by Professor Chua Chung Nen

This 55 year-old woman fell off her motorbike 8 weeks ago and hit her right temple against the pavement. She developed a right lower facial nerve palsy. CT scan showed fracture of the right mastoid bone. Despite a good Bell's phenomenon, constant topical artificial tear and tapping of the eyelid at night, she developed exposure keratitis. However, she declined eyelid surgery to reduce the ocular exposure. A pair of swimming goggles were used as moist chamber and the exposure keratitis improved after a few days of wear. To reduce condensation on the inside of goggles, a few needle holes were created on the goggles.

 

Figure 1. Right lower facial nerve palsy showing right eyebrow ptosis and upper eyelid retraction. Incomplete eyelid closure with corneal and conjunctival exposure.

 

Figure 2. Swimming goggles used as moist chamber.

 

Figure 3. A tight fit is important for the goggles to act as moist chamber.

 

Figure 4. CT scan with arrow pointing to the site of the mastoid fracture.

 

Figure 5. Another view of the fractured mastoid bone.

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