Trans-tensor tympani facial nerve decompression in traumatic facial nerve palsy.

OBJECTIVE: The surgical approaches previously reported for facial nerve decompression have focussed on achieving good exposure of the lateral or superior aspects of the geniculate ganglion. This report aims to describe a unique case of facial nerve decompression beneath the geniculate ganglion. PATIENT: A 30-year-old woman with right-sided facial palsy due to a temporal bone fracture. INTERVENTION: Bony fragments at the base of the geniculate ganglion were removed via a trans-tensor tympani approach with extended posterior tympanotomy. RESULTS: The patient's facial movement recovered successfully, without complications such as sensorineural hearing loss and conductive hearing loss. CONCLUSION: In rare cases requiring decompression of the facial nerve inferior to the perigeniculate area, the trans-tensor tympani approach should be considered as a valuable alternative option when surgical intervention is considered.