Surgical management of traumatic intratemporal facial nerve paralysis: Looks matter! Uma Patnaik, Garima Upreti, Ajith Nilakantan Indian Journal of Otology 2019 25(1):11-17 Objective: Patients with traumatic intratemporal facial paralysis often present late to the otologist, as assessment may be difficult due to altered neurological status, or the management of associated neurosurgical emergency takes precedence. Recommendations for surgical management of these patients are contentious, especially when the patient presents late to the otologist or when the history is dubious. The purpose of this study was to analyze the outcomes of surgery in these patients with regard to onset, clinical findings, timing of surgery, and recovery of facial nerve (FN) function; compare it with similar studies conducted in the past decade; and propose a management guideline for such cases. Study Design: Prospective cohort study. Methodology: Outcome analysis in patients who underwent surgical exploration for traumatic intratemporal FN paralysis at our tertiary care center from January 2008 to December 2015 was done. A detailed record of the history of onset and clinical findings with preoperative status of FN function and hearing status was made. Radiological findings and electrodiagnostic tests influenced the decision-making with respect to surgical exploration. Our observations regarding timing of surgery post trauma, intraoperative findings, and postoperative recovery of FN function were evaluated and outcomes were compared with similar studies in the last decade. Results: Eleven patients were included in the study. All patients had House–Brackmann Grade (HBG) V/VI paralysis prior to surgery. Time interval between injury and surgery ranged between 5 and 176 days (average 58 ± 55 days). Follow-up after surgery ranged from 9 to 72 months (average 31 ± 18 months). Two patients recovered to HBG I, 5 to HBG II, and 4 to HBG III. Conclusion: Surgical exploration for traumatic facial paralysis is often delayed due to late presentation to the otologist. Surgery should not be denied to patients presenting late, or with uncertain history, as it will still give significant recovery to the patient. We have also proposed a guideline for the management of such cases.