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Key methods of identifying the horizontal facial nerve during difficult middle-ear surgery

  • M I Syed (a1), M Madurska (a1) and B F O'Reilly (a2)

Abstract

Background:

The key to avoiding damage to the horizontal facial nerve in middle-ear surgery is to formally identify the nerve in the early stages of the procedure.

Methods:

In the non-infected ear this can be achieved relatively easily by identifying the oval window niche. However, in the infected ear with cholesteatoma, the safest landmark to use is the processus cochleariformis, which can be identified by three different methods.

Conclusion:

In an infected ear that is full of granulation tissue and/or cholesteatoma, the horizontal facial nerve can be reliably identified by locating the processus cochleariformis using the three methods described. This avoids damage to the nerve and important structures around it.

Copyright

Corresponding author

Address for correspondence: Mr M I Syed, Department of Otolaryngology, Raigmore Hospital, Inverness IV2 3UJ, Scotland, UK E-mail: iqbalms@hotmail.com

References

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1Sullivan, JA, Smith, JB. The otological concept of Bell's palsy and its treatment. Ann Otol Rhinol Laryngol 1950;59:1148–70
2Haynes, DR. The relations of the facial nerve in the temporal bone. Ann R Coll Surg Engl 1955;16:175–85
3Baxter, A. Dehiscence of the Fallopian canal. An anatomical study. J Laryngol Otol 1971;85:587–94
4Măru, N, Cheiţă, AC, Mogoantă, CA, Prejoianu, B. Intratemporal course of the facial nerve: morphological, topographic and morphometric features. Rom J Morphol Embryol 2010;51:243–8
5Goin, DW. Proximal intratemporal facial nerve in Bell's palsy surgery. A study correlating anatomical and surgical findings. Laryngoscope 1982;92:263–72

Keywords

Key methods of identifying the horizontal facial nerve during difficult middle-ear surgery

  • M I Syed (a1), M Madurska (a1) and B F O'Reilly (a2)

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