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September 1968

Transtapedial Congenital Malposition of the Facial Nerve

Author Affiliations

Ann Arbor, Mich
Dr. Butler is in private practice in Ann Arbor, Mich.

Arch Otolaryngol. 1968;88(3):268. doi:10.1001/archotol.1968.00770010270011

ALTHOUGH many unusual congenital anomalies of the intratympanic course of the facial nerve have been described, none have been similar to the one I discovered during ear surgery for chronic suppurative disease.

Report of a Case  The patient was a 60-year-old nurse anesthetist who had known chronic suppurative otitis media from childhood. The examination of the right tympanic membrane revealed a posterior superior perforation with cholesteatomatous debris in the middle ear and antrum precipitated by pain in the ear which could not be adequately removed during the office examination.A modified radical mastoidectomy and tympanoplasty were carried out under general anesthesia and during the intratympanic course of the dissection the stapes was exposed while elevating the limiting membrane of the cholesteatoma. I immediately observed that there was a large round nonpulsatile structure passing through the arch of the stapes crura and almost completely filling the space (Figure). The stapes was

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