Learning Objectives: Facial paralysis can occur after surgery for cholesteatoma. Rate of FND was reported 13% in our serie, suggesting that otologist should be highly vigilant when dissecting near the FN.

Objective: The objective of this retrospective study was to identify the incidence of facial nerve dehiscence (FND) in patients undergoing tympanoplasty for cholesteatoma.

Patients and method: We retrospectively reviewed 224 patients, who underwent tympanoplasty performed by a single surgeon between 2012 to 2014. We collected following data: kind of surgery (canal wall up (CWU) or canal wall down with mastoid obliteration (CWD), FND and its location after exenteration of disease, labyrinthine fistula, dural exposure and preoperative and postoperative facial function.

Results: The incidence of FND was 13% (29/224 ears) for total surgical procedures, 0.1% for CWU tympanoplasty (23/208), 38% for CWD tympanoplasty (6/16). The most common site of dehiscence (90%, 26/29) was the tympanic segment, posterior to the cochleariform process in 18 cases. We find 11 patients with labyrinthine fistula (5%) and 3 with dural exposure (1%). All but one have normal preoperative FN function, all retained normal function postoperatively.

Conclusion: In our series, incidence of facial nerve dehiscence and labyrinthine fistula was similar to the data reported in the literature. All patient retained normal function postoperatively.