Can a facial fall cause nerve damage, and how is it managed?

From the Guidelines

Yes, a facial fall can cause nerve damage, particularly to the facial nerve (cranial nerve VII) or trigeminal nerve (cranial nerve V), and management depends on the severity of the injury. The facial nerve carries nerve impulses to muscles of the face and also to the lacrimal glands, salivary glands, stapedius muscle, taste fibers from the anterior tongue, and general sensory fibers from the tympanic membrane and posterior ear canal 1. For mild nerve damage, conservative treatment includes rest, over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours), and applying ice packs for 15-20 minutes several times daily during the first 48 hours to reduce swelling.

If you experience facial numbness, weakness, or paralysis, seek immediate medical attention as these are signs of significant nerve damage. A healthcare provider may prescribe corticosteroids like prednisone (typically 60mg daily for 5 days, then tapered) to reduce inflammation around the nerve, as seen in the treatment of Bell’s palsy 1. Physical therapy with facial exercises may be recommended to maintain muscle tone and prevent contractures. For severe cases, surgical intervention might be necessary to repair the damaged nerve. Recovery from nerve damage can take weeks to months, and complete healing isn't always guaranteed.

The facial and trigeminal nerves are vulnerable during falls because they run through narrow bony canals in the face, and trauma can cause compression, stretching, or direct injury to these nerves, disrupting their ability to transmit signals between the brain and facial muscles or sensory receptors. Injuries to the midface, such as zygoma fractures, naso-orbital-ethmoid fractures, and maxilla fractures, can also occur due to facial trauma and may require imaging and surgical intervention 1.

Some key points to consider in managing nerve damage from a facial fall include:

• Seeking immediate medical attention if symptoms of significant nerve damage are present
• Using conservative treatment for mild nerve damage, such as rest and pain relievers
• Considering corticosteroids and physical therapy for more severe cases
• Being aware of the potential for long-term poor outcomes, such as incomplete recovery or persistent facial weakness.

From the Research

Nerve Damage from Facial Fall

• Nerve damage can occur from a facial fall, which may result in peripheral nerve injury facial pain 2.
• The severity of the injury can vary, and some cases may not respond to traditional medication like analgesics 2.

Management of Nerve Damage

• Pregabalin has been shown to be effective in the treatment of post-traumatic peripheral nerve injury facial pain 2.
• Gabapentin has also been found to alleviate affective pain after traumatic nerve injury 3 and can provide relief from affective pain without producing sedation.
• Local anesthetics can exacerbate motoneuron death and delay functional recovery after a peripheral nerve injury, although the effects vary depending on the type of anesthetic used 4.
• Supraspinal mechanisms may play a role in the antihypersensitivity actions of gabapentin and pregabalin after peripheral nerve injury 5.

Treatment Options

• Pregabalin can be used to manage post-traumatic peripheral nerve injury facial pain, with common adverse effects including dizziness and tiredness 2.
• Gabapentin can be used to alleviate affective pain after traumatic nerve injury, with a dose of 100 mg/kg found to be effective in preclinical studies 3.
• Care should be taken when using local anesthetics, as some may worsen nerve damage or delay recovery 4.