title: Retrofacial approach to access the round window for cochlear implantation of malformed ears.
abstract: OBJECTIVE
  To report the use of the retrofacial approach for cochlear implantation in three cases of malformed ears with inaccessible round windows through the standard facial recess.
  
  
  METHODS
  Two children with bilateral profound sensorineural hearing loss who were cochlear implant candidates. One patient had bilateral sequential cochlear implantations and the other a unilateral implant.
  
  
  METHODS
  Retrofacial approach to access the posterior mesotympanum and visualize the round window.
  
  
  METHODS
  Ability to complete the surgery with full insertion of the implant and no complications such as facial nerve injury.
  
  
  RESULTS
  We implanted three ears in two patients with multiple external and middle ear malformations with an aberrant facial nerve or a posteriorly displaced round window niche. The standard facial recess approach did not allow visualization of the round window. We resorted to a retrofacial approach to access the posterior mesotympanum and proceeded with the surgery through an anterior and inferior cochleostomy or through the round window.
  
  
  CONCLUSIONS
  In cases with an aberrant facial nerve or inaccessible round window through the facial recess, the retrofacial approach is a good alternative but requires a certain level of expertise and familiarity with temporal bone anatomy. The decision to use an unconventional approach should be considered before surgery, but the ultimate decision may require intraoperative assessment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: Habib
authors.initials: H
authors.lastname: Rizk
authors.forename: Brendan
authors.initials: B
authors.lastname: O'Connell
authors.forename: Shawn
authors.initials: S
authors.lastname: Stevens
authors.forename: Ted
authors.initials: T
authors.lastname: Meyer
mesh_terms: D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D004423:Ear / Q000002:abnormalities*; D006319:Hearing Loss, Sensorineural / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012405:Round Window, Ear / Q000601:surgery*; D013701:Temporal Bone / Q000601:surgery*; D016896:Treatment Outcome