Cochlear implantation becomes more common with every passing year. Since adequate exposure of the round window requires a facial recess approach, facial nerve variation and anomalies could potentially alter the surgical approach significantly. We report the case of a patient with a variation of facial nerve anatomy. The nerve was found to be lateral to the annulus in its mastoid segment and required retrofacial dissection to approach the round window. A good result was achieved in this patient, demonstrating that facial nerve anomalies need not be a barrier to successful implantation. The reported congenital anomalies of the facial nerve are discussed, along with their influence on cochlear implantation. A knowledge of these variations is mandatory for those engaged in implant surgery.
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