Terminal facial nerve palsy – A diagnostic dilemma

Abstract

The pterional or frontotemporal sphenoidal approach to craniotomy is an extensively used neurosurgical technique to expose different structures in cranial fossae. Two middle-aged patients presented to the clinic with loss of forehead creases, and unilateral brow ptosis. This article aims to detail the findings in two patients with selective frontal branch of facial nerve palsy after undergoing craniotomy through the pterional approach. Though facial nerve palsy is classified as upper motor neuron/lower motor neuron palsy, this case scenario highlights the importance of isolated involvement of the frontal branch of the facial nerve. Thus, it is important to highlight these findings to create awareness among ophthalmologists who may come across such a clinical picture while examining neurosurgery patients so that they are better enabled to localize the cause.