title: Anatomical facial nerve findings in 209 consecutive atresia cases.
abstract: OBJECTIVE
  Describe intraoperative facial nerve findings in 209 consecutive atresia cases. Identify preoperative and intraoperative anatomical variants that should alert the surgeon to potential high-risk facial nerve anatomy.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care subspecialty private practice.
  
  
  METHODS
  Retrospective review of 209 consecutive atresia cases treated between 2007 and 2011. Descriptive analysis of intraoperative findings. Logistical regression models with generalized estimating equations were used to examine the effect of preoperative variables over the operative findings.
  
  
  RESULTS
  Two hundred and nine consecutive patients (ages 2-48) underwent atresia repair between 2007 and 2011. Preoperative Jahrsdoerfer Scale was 9 (23%), 8 (42%), 7 (19%), 6 (2%), 5 or less (2%). 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. The stapedius tendon was absent in 30% of cases. A single patient had a mild transient postoperative paresis (House-Brackmann 2).
  
  
  CONCLUSIONS
  Atresia repair remains one of the most challenging procedures in otology. In spite of modern preoperative imaging, the facial nerve remains at risk. When performing surgery on patients with preoperative facial nerve paresis and/or lower Jahrsdoerfer scores, the surgeon should be aware of a higher incidence of facial nerve abnormalities. Thorough knowledge of anatomical variations and meticulous surgical technique are mandatory to safely perform these surgeries.
authors: California Ear Institute, Palo Alto, California 94303, USA.
authors: Hernan
authors: H
authors: Goldsztein
authors: Joseph B
authors: JB
authors: Roberson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000601:surgery*; D065817:Congenital Microtia; D004423:Ear / Q000002:abnormalities* / Q000601:surgery*; D005154:Facial Nerve / Q000002:abnormalities / Q000033:anatomy & histology* / Q000601:surgery; D020220:Facial Nerve Injuries / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult