(848) Facial Nerve and Otologic Outcomes After Temporal Bone Gunshot Wounds

Introduction: Gunshot wounds (GSWs) involving the temporal bone are rare but severe injuries with substantial otologic and neurologic morbidity. Prognostic data regarding facial nerve (FN) outcomes, cerebrospinal fluid (CSF) leak, and survival remain limited.

Methods: A retrospective review was performed of adult patients presenting to a single tertiary center between 2014 and 2024 with CT-confirmed temporal bone fractures secondary to GSWs. Demographics, injury characteristics, radiographic findings, and clinical outcomes were collected. Outcomes included FN function, CSF leak, neurosurgical intervention, and mortality. FN function was graded using the House-Brackmann (HB) scale.

Results: Six patients met inclusion criteria. Complete FN paralysis (HB VI) was present at initial evaluation in 4 patients (67%). CT demonstrated facial canal violation in 3 (50%), often with ossicular disruption and complex fracture patterns; otic capsule involvement was uncommon (17%). During follow-up, persistent severe FN dysfunction predominated. Among patients with facial canal violation, 2 of 3 (67%) showed no improvement from HB VI, while partial recovery to HB III occurred in select cases, either following FN reconstruction or when canal violation was absent. Audiometry was available in 4 patients, demonstrating profound sensorineural hearing loss in 2, moderate-severe loss with poor word recognition in 1, and milder loss with preserved speech discrimination in 1, without meaningful recovery. One patient required neurosurgical intervention; no CSF leaks or deaths were observed. Otologic surgery was performed in 2 patients (33%), directed toward structural management or FN reconstruction rather than hearing restoration.

Conclusions: GSWs to the temporal bone result in severe otologic injury with a high likelihood of persistent FN paralysis and irreversible hearing loss, particularly when the facial canal is violated. These findings provide realistic prognostic expectations and highlight the limited role of otologic intervention beyond management of associated injuries.