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

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Anatomy

Background:

• Damage to the horizontal facial nerve during middle-ear surgery can be avoided by early identification.
• In non-infected ears, the oval window niche is a common landmark.
• Infected ears with cholesteatoma present unique challenges for nerve identification.

Purpose of the Study:

• To present a reliable method for identifying the horizontal facial nerve in infected middle-ear conditions.
• To detail the use of the processus cochleariformis as a key landmark in cholesteatoma surgery.

Main Methods:

• Describing three distinct methods for identifying the processus cochleariformis.
• Utilizing the processus cochleariformis as a landmark in cases of granulation tissue and/or cholesteatoma.
• Focusing on surgical navigation within the infected middle ear.

Main Results:

• The processus cochleariformis can be reliably identified even in infected ears.
• This landmark allows for precise localization of the horizontal facial nerve.
• Successful identification prevents inadvertent nerve damage.

Conclusions:

• Locating the processus cochleariformis is a safe and effective strategy for identifying the horizontal facial nerve in infected ears.
• This technique minimizes the risk of damage to the facial nerve and surrounding structures.
• The described methods enhance surgical safety in complex middle-ear procedures.