Facial Nerve Findings in 210 Consecutive Atresia Repairs

Abstract

Objective: Describe intraoperative facial nerve findings in 210 consecutive atresia cases. Identify preoperative and intraoperative anatomical variants that should alert the surgeon to potential high-risk facial nerve anatomy.

Method: Retrospective review of 210 consecutive atresia cases treated between 2007 and 2011 at a subspecialty private practice. Descriptive analysis of intraoperative findings.

Results: Two hundred and ten consecutive patients (ages 2-47) underwent atresia repair between 2007-2011. Preoperative Jahrsdoerfer Scale was 9 (26%), 8 (47%), 7 (21%), 6 (3%), and 5 or less (4%). The facial nerve was found to have an abnormal course in 39% of the cases and not identified in 1%. It was congenitally dehiscent in 53% of cases and was surgically exposed in 10%. The most common site of congenital dehiscence was in the tympanic segment (57%). Facial-stapes contact was found in 11% of cases. A single patient had a transient postoperative mild paresis (House-Brackmann 2) as a consequence of surgery.

Conclusion: Atresia repair remains one of the most challenging procedures in otology. Despite modern preoperative imaging, the facial nerve remains at risk given the variable development of the first and second branchial arches. Thorough knowledge of anatomical variations and meticulous surgical technique are mandatory to safely perform these surgeries.