Cochlear implantation requiring a retrofacial approach to the round window

Objective To describe three cases of cochlear implantation utilizing a retrofacial approach to the round window. Study Design Retrospective case review. Patients Three patients with sensorineural hearing loss undergoing cochlear implantation. Interventions Cochlear implantation via a retrofacial approach to the round window. Results Three patients were noted to have inadequate visualization of the round window using a standard posterior tympanotomy at the time of their cochlear implant surgery. A retrofacial approach was performed to provide exposure of the round window to ensure correct placement of the electrode array. Intraoperative photos and postoperative imaging are demonstrated. Conclusion When a laterally or anteriorly positioned facial nerve obscures visualization of the round window, a retrofacial approach is a possible route to visualize the round window.