Deceptive Facial Nerve Variant May Cloud Otologists' Judgment: A Dilemma in Middle Ear Surgery

Tympanomastoid surgery constitutes the vast majority of procedures performed by otologists. Intra-operatively, identifying the facial nerve is always a challenge. We present an unusual case of fibrous connective tissue mimicking a facial nerve variant during cholesteatoma surgery. The variant was inadvertently damaged during surgery, and we feared devastating complications; however, the pathology revealed that it was not the actual facial nerve. This case is important, in that it serves as a reminder for otologists to be aware of the many possible presentations of the facial nerve in otologic surgery.