title: Key methods of identifying the horizontal facial nerve during difficult middle-ear surgery.
abstract: BACKGROUND
  The key to avoiding damage to the horizontal facial nerve in middle-ear surgery is to formally identify the nerve in the early stages of the procedure.
  
  
  METHODS
  In the non-infected ear this can be achieved relatively easily by identifying the oval window niche. However, in the infected ear with cholesteatoma, the safest landmark to use is the processus cochleariformis, which can be identified by three different methods.
  
  
  CONCLUSIONS
  In an infected ear that is full of granulation tissue and/or cholesteatoma, the horizontal facial nerve can be reliably identified by locating the processus cochleariformis using the three methods described. This avoids damage to the nerve and important structures around it.
authors: Department of Otolaryngology, Raigmore Hospital, Inverness, Scotland, UK. iqbalms@hotmail.com
authors: M I
authors: MI
authors: Syed
authors: M
authors: M
authors: Madurska
authors: B F
authors: BF
authors: O'Reilly
mesh_terms: D004432:Ear, Middle / Q000294:innervation / Q000601:surgery*; D005154:Facial Nerve; D005158:Facial Paralysis / Q000517:prevention & control*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D013506:Otologic Surgical Procedures / Q000379:methods*