Abducent nerve palsy following transverse fracture of the middle cranial fossa.

Transverse sphenoidal fractures may be associated with a variety of skull base injuries and neural deficits. Among those nerve injuries, oculomotor palsies and particularly sixth cranial nerve palsy, are quite common. Blows on the side of the head in the squamous temporal region may run across the floor of the middle cranial fossa through the greater wing of the sphenoid in the transverse cranial axis. We report three cases of patients who had sustained craniofacial injury which included a transverse fracture of the middle cranial fossa through the sphenoid sinus, extending to the petrous apex and producing abducent, facial, and eighth nerve dysfunction. Spontaneous recovery from diplopia occurred in all cases within 4 months. The management of the patients and the patterns of transverse cranial base fractures and their associated clinical features are discussed.