Iatrogenic facial paralysis prevention.

Iatrogenic facial paralysis occurs in less than 4% of major otologic procedures. The prevention of iatrogenic injuries involves study, training and experience. These concepts are carefully woven into residency training, fellowship and, ultimately, into peer review. The reasons for injury may be errors of omission, such as inadequate preparation for the procedure, or errors of commission, such as inadequate surgical exposure. Currently, there appear to be enough surgical cases for training programs and the core training of otolaryngology residents prepares them to handle most facial nerve problems. Included in this article is a more detailed description of the anatomy in and around the facial nerve, particularly in the mastoid, with suggestions on how to avoid problems and reduce injuries.