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Related Experiment Video

Updated: May 2, 2026

Step-by-Step Stapedotomy through Transcanal Exclusive Endoscopic Approach
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Stapes fixation accompanied with abnormal facial nerve pathway.

Taro Inagaki1, Atsushi Kawano1, Yasuo Ogawa1

  • 1Department of Otolaryngology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.

Auris, Nasus, Larynx
|March 4, 2014
PubMed
Summary

This case study highlights a rare occurrence of otosclerosis with an abnormal facial nerve pathway. Surgical intervention successfully addressed the hearing loss by repositioning the nerve and performing stapedotomy.

Keywords:
Abnormal facial nerve pathwayOtosclerosisStapes surgery

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Medical Imaging

Background:

  • A 52-year-old woman presented with long-standing bilateral hearing loss, worsening in the left ear.
  • Audiometry revealed bilateral mixed hearing loss (Right: 52 dB, Left: 68 dB).
  • Computed tomography (CT) of the temporal bone showed no significant abnormalities.

Observation:

  • Intraoperative findings during surgery for suspected otosclerosis revealed a white band beneath the stapes superstructure.
  • Nerve monitoring confirmed this band to be the facial nerve.
  • The stapes superstructure was malformed due to the aberrant facial nerve, with a fixed footplate.

Findings:

  • Diagnosis of otosclerosis with an abnormal facial nerve pathway was established.
  • Surgical management involved careful removal of the malformed stapes superstructure.
  • Repositioning the ectopic facial nerve allowed visualization of the oval window for stapedotomy.

Implications:

  • This case underscores the importance of intraoperative identification of anomalous facial nerve anatomy during otologic surgery.
  • Successful stapedotomy with a Teflon piston prosthesis was achieved despite the complex anatomy.
  • Highlights the need for advanced techniques in managing hearing loss associated with unusual anatomical variations.