[Vestibulotomy about the displaced facial nerve]

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Innovation

Context:

• Congenital conductive hearing loss presents significant challenges, often complicated by middle ear deformities and facial nerve anomalies.
• Anatomical variations such as facial nerve overhang can obscure the oval window, complicating traditional surgical approaches.
• Vestibulotomy is a surgical procedure to create an opening into the vestibule of the inner ear.

Purpose:

• To evaluate the feasibility and outcomes of performing vestibulotomy superior to a displaced facial nerve.
• To assess the efficacy of this technique in restoring hearing in patients with complex congenital ear malformations.
• To determine the safety profile regarding facial nerve integrity.

Summary:

• Eight patients with severe congenital conductive hearing loss underwent vestibulotomy above a displaced facial nerve, with or without facial nerve transposition, and ossicular chain reconstruction.
• Significant hearing improvement was observed, with 15 dB gain in 2 ears, 16-25 dB in 3 ears, and >26 dB in 3 ears.
• Postoperative follow-up revealed stable hearing gains and no instances of facial nerve paresis.

Impact:

• Vestibulotomy above the displaced facial nerve provides a crucial surgical pathway for hearing restoration in challenging cases.
• The procedure demonstrates a favorable safety profile, preserving facial nerve function.
• This technique expands surgical candidacy for patients with otherwise marginal or poor prognoses for hearing improvement.