Anterior facial nerve decompression.

With the current interest in skull base surgery and the resurgence of cavity surgery in the management of cholesteatoma, the otologic surgeon should be able to approach the facial nerve anteriorly as well as posteriorly. The anatomy and identification of the facial nerve are traditionally taught from a transmastoid perspective. In many cases of skull base and chronic ear surgery, it would often be more efficacious if the facial nerve were identified by a transcanal or anterior approach. An anterior approach to the facial nerve expedites surgery in a small sclerotic mastoid process and gives maximum exposure of disease in the hypotympanum and tympanic recess.