The Anterior Hinge and Posterior Hinge Techniques for Mobilizing the Intratemporal Facial Nerve

Accessing the central skull base often requires mobilization of the intratemporal facial nerve. The most common methods require swinging the facial nerve either anteriorly or posteriorly after dissecting the nerve from the fallopian canal. Posterior mobilization usually causes intraoperative deterioration in electrophysiological function and can lead to significant postoperative facial paresis.

We describe a new technique for anterior and posterior mobilization of the facial nerve that minimizes intraoperative facial nerve injury. The hinge techniques rely on skeletonizing the facial nerve, leaving the bony fallopian canal intact, so that the vascular supply is not compromised. Hinges are created at set points along its course to enable the nerve to be swung at the stylomastoid foramen and second genu for the anterior hinge, and in addition, at the internal auditory meatus for the posterior hinge technique.

Intraoperative electrophysiological results suggest that facial function is maintained after mobilization. The presentation will include video demonstrations of both techniques and supporting electrophysiological data.