Stylohyoid fracture resulting in facial paralysis.

A female patient in her early 30s was referred to the otology clinic for progressive left facial paralysis. Two weeks prior to the onset of the paralysis, she had heard a loud cracking sound when drinking water. A CT scan showed a left styloid fracture near the stylomastoid foramen, compressing the facial nerve. Varicella IgG and IgM were negative, but the patient was started on a tapering course of steroids and valacyclovir. Approximately 1 month after the original incident, her left facial nerve paralysis improved. This report describes the unusual cause of facial paralysis and discusses the importance of history taking and imaging studies.