Retrofacial approach to access the round window for cochlear implantation of malformed ears.

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.

PATIENTS: 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.

INTERVENTION(S): Retrofacial approach to access the posterior mesotympanum and visualize the round window.

MAIN OUTCOME MEASURE(S): 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.

CONCLUSION

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.