Aims Petrous temporal bone fractures with complete facial nerve palsies are rare and timing of repair is controversial. We present a case report of delayed surgical decompression of a left facial nerve beyond six weeks of injury with improvement from a House Brackmann VI to IV at eight months. Methodology A literature review and retrospective case report was performed reviewing clinical presentation, management, and outcomes. Results A 45-year-old male sustained a crush injury resulting in multiple skull base fractures. CT revealed a displaced left longitudinal temporal bone fracture with a transverse component through the left petrous apex and geniculate ganglion. He had no active left facial movement and was graded a complete House Brackmann VI palsy on initial examination and started on high-dose steroids within 24 hours. He also had confirmed left-sided CSF otorrhoea. An electroneurogram was performed on the fourth day of injury and showed no stimulation of left-sided facial muscles. He underwent delayed exploration on day 46 of his injury via a transmastoid approach. A small spicule of bone in the tympanic segment of the facial nerve was identified near the geniculate ganglion. At the four month follow up review, he noticed his left facial tone and definition improving. He had improved nasolabial fold symmetry and new active function of his orbicularis oris. At the eight-month follow up review he had further gains in his lower branches. He had palpable contraction of lip elevators, depressors and commissure and was able to achieve platysma contraction and protective eye closure. He was graded a House Brackmann IV and decision was made to not undergo any reconstruction. Conclusion Surgical decompression after six weeks can still show recovery and should be considered. This is consistent with previous reports where satisfactory recovery was seen up to three months post-injury.