Retrofacial approach of cochlear implantation in inner ear malformation with aberrant facial nerve: A case report

Cochlear implantation is regarded as a safe surgery for young children with minimal complications. However, inner ear malformations and aberrant course of facial nerves may impede electrode insertion via the round window approach and increase the risk of iatrogenic facial nerve injury. We report a case of cochlear incomplete partition in a patient with anomalous facial nerve anatomy. The anterior and inferior displacement of the facial nerve obscured the round window. A retrofacial approach was used to expose the round window and the electrode was inserted successfully. No surgical complications were found postoperatively, and the child showed significant improvement in speech perception. As the course of the aberrant facial nerve is difficult to track preoperatively, surgeons should proceed with caution to reduce the risk of facial nerve injury during the operation.