To avoid the difficulties encountered with other techniques, we use the cochleariform process in the middle ear as the primary landmark for identifying the tympanic segment of the facial nerve.
The surgeon opened a small hole with a diamond bur and identified the cochleariform process and the adjacent segment of the facial nerve (figure 4).
The purpose of this article is to describe a fast and safe technique to expose the geniculate ganglion and the labyrinthine portion of the facial nerve in two structures of the middle ear: the cochleariform process and the tympanic portion of the facial nerve.
A second plaque of tympanosclerosis was seen medial to the neck of the malleus, bridging the gap between it and the cochleariform process
and extending to the chorda tympani nerve.
They include the absence of the foramen spinosum on the affected side and the enlargement of the proximal tympanic segment of the facial nerve canal adjacent to the cochleariform process
The surgical technique involves exposure of the geniculate ganglion, the greater petrosal nerve, and the facial nerve from the cochleariform process
to the cerebellopontine angle via the middle cranial fossa approach.