Surgical exposure of the facial nerve: contemporary transtemporal techniques.

Contemporary surgical exposure of the facial nerve has as its aims adequate exposure of the facial nerve at any point in its course, with preservation of hearing and vestibular function, and without further injury to the facial nerve and the necessity for producing a mastoid cavity. Today it is surgically possible to expose the facial nerve from the brainstem to its terminal branches in the face. A decade of experience has shown that if the operator is armed with intimate anatomic knowledge of the temporal bone and middle and posterior fossae, and if the principles of facial nerve surgery outlined earlier are meticulously adhered to, these aims may be accomplished. A system of surgery has been presented in detail with discussion of the advantages, disadvantages, and technique of the operation. By utilizing the appropriate procedure or combination of procedures, the otologic surgeon will realize the goals of predictable and safe surgical exposure of the facial nerve.