Unmasking the uncommon symptoms of delayed facial nerve palsy following head trauma in a child: A case report

Facial nerve paralysis is a relatively rare neurological condition in children, often associated with head trauma. Delayed facial nerve palsy (dFNP) after trauma is an uncommon phenomenon that poses diagnostic and therapeutic challenges. A 6-year-old boy sustained a head injury in a motor vehicle accident that resulted in a temporal bone fracture. Ten days later, he presented with progressive right-sided facial weakness, diagnosed as post-traumatic dFNP. Imaging revealed a minimally displaced right temporal bone fracture, a ruptured arachnoid cyst, and a frontal contusion. He was treated with a tapering oral corticosteroid regimen, eye lubrication, and physical therapy. Surgical decompression was performed due to persistent symptoms. At follow-up, the patient had complete symptom resolution. This case highlights the importance of recognizing dFNP as a delayed complication of pediatric head trauma. Early diagnosis and multidisciplinary management improve outcomes. Clinicians should educate families about the possibility of delayed symptom onset to avoid misdiagnosis.