Alvaro Campero, Pablo Ajler, Mariano Socolovsky, Carolina Martins, Albert Rhoton

Surgical Neurology International 2012 3(7):400-404

Background: Hypoglossal-facial anastomosis is the gold standard treatment for facial reanimation in those cases where the facial nerve has been damaged near the brainstem. The technique that requires temporal bone drilling and partial section of the hypoglossal nerve is usually preferred. This technique diminishes tongue morbidity while preserves good facial reanimation. The goal of the present work is to describe a simple technique to expose the mastoid portion of the facial nerve. Methods: The mastoid portion of the facial nerve runs on the anterior wall of the mastoid process; mean 18+/-3 mm deeply to the lateral wall. The supramastoid crest has to be identified; a parallel line is marked from the crest to the mastoid tip, and bone drilling is performed anterior to the line. Once the facial nerve is identified, proximal and distal dissection is performed. Results: This limited approach allows to a safe exposure of the mastoid segment of the facial nerve. This procedure is technically less demanding but should be restricted to hypoglossal-facial anastomosis Conclusion: Surgeons not fully experienced in temporal bone drilling can do this simple approach after performing some laboratory practice.