Several surgeons have reported that radical extirpation of lesions in the temporal bone is very difficult. Extirpation can be particularly challenging when tumors involve the area surrounding the jugular bulb and tympanic sinus, which is anatomically very complex, specifically with regard to the relationship between the facial nerve and jugular bulb. The main causes of such problems associated with structural complexities are insufficient surgical view and difficulty securing hemostasis. We encountered 2 cases of benign intra-temporal lesions and operated using a intraoperative facial nerve anterior transposition. Such methods involve temporarily moving the appropriate part of the facial nerve anteriorly.
The first case was a glomus hypotympanicum classified as Fisch class B, while the second was recurrent cholesteatoma that had extended into the internal auditory canal. We selected extended posterior tympanotomy for the glomus hypotympanicum and a trans-cochlear approach for the cholesteatoma. These cases were complicated by mild postoperative facial nerve palsy which, however, recovered completely and rather rapidly. Although a retro-facial approach is generally considered more suitable for preservation of facial nerve function due to no direct procedures in the nerve, we believe that a benefit of the intraoperative anterior transposition of the facial nerve is widening of the operational field and ease of manipulation.
We therefore postulate that the intraoperative anterior transposition of the facial nerve in these operations can enable surgeons not only to perform the procedures safely but also to remove such tumors rather completely.
