Facial nerve injury and post traumatic facial nerve paralysis after temporal bone fracture are the challenge regarding its management. It is controversial to decide whether it should be managed conservatively alone or should undergo surgical management. It is also a dilemma that when to operate and how much the nerve to decompress. The main aim of our study to set the criteria regarding decision making for the management of patient having facial nerve paralysis after temporal bone fracture. We also analyze postoperative results or recovery of patients underwent surgical procedures. In this study we select and analyze 18 patients having temporal bone fracture from 2016 to 2022. Patient evaluate and assessed clinically, audiologically and also with electrophysiological diagnostic techniques. All 18 patients receive medical treatment initially. Then based on the criteria of complete clinical paralysis at onset, no improvement with conservative treatment and fibrillation potential in EMG, only 7 patients underwent surgical decompression through transmastoid approach. In these patient lesions found predominantly in geniculate ganglion area. Analysis of results done after 12 months after the day of injury. In medically managed patients i.e. 11 patients, 90% had good recovery (H B grade I- II) and in surgically managed patients i.e. 7, 80% patients have good recovery. The patient selection for medical and early surgical intervention based on clinical examination and judicious use of electrodiagnostic tests plays a vital role in outcome in the management of posttraumatic facial nerve paralysis.