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Updated: Aug 8, 2026

The Microscopic Transcanal Approach in Stapes Surgery Revisited
Published on: February 16, 2022
A bifid intra-tympanic facial nerve in association with a normal stapes
J Ahmed1, P Chatrath, J Harcourt
1Department of Otolaryngology, Charing Cross Hospital, London, UK. jayahmed11@hotmail.com
Abstract:
A rare facial nerve anomaly was incidentally discovered whilst performing a tympanoplasty and ossicular reconstruction on a patient with an acquired unilateral conductive hearing loss. The nerve was seen to bifurcate and straddle a normal stapes superstructure as it ran posteriorly through the middle ear, a unique and as yet unreported combination. This case highlights the importance of vigilance regarding facial nerve anatomical variations encountered during middle-ear surgery thus avoiding inadvertent damage. The purported embryological mechanism responsible for such anomalies of the intra-tympanic facial nerve is discussed.
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