Skeletonizing the facial nerve underwater: A pilot study

Objective: Drilling of the facial recess represents an important step in cochlear implant (CI) surgery. It is crucial for the next step of exposing the round window. This study sought to evaluate the efficacy of underwater drilling (UWD) during the opening of the facial recess for CI surgery. Materials and Methods: This was a prospective clinical pilot study performed at a quaternary care center. We included adult and pediatric patients who underwent bilateral simultaneous CI surgeries. Any patients with facial nerve anomalies or previous ear surgery were excluded from the study. Drilling of the facial recess on one side was performed using UWD (case side); on the other side (control side), drilling was performed by minimal water drilling (MWD). Drilling was performed by the same surgeon on both sides. The time differences between the procedures were recorded. Results: A total of 21 patients were included in this study; 66% (14/21) were males, and the mean age was 8.25 years (standard deviation ± 12.00 years) at the time of surgery. UWD was completed, and the results of a normal facial nerve examination were documented postoperatively. The time needed for UWD (12 ± 6.72 min) was slightly shorter than the time needed for MWD (13 ± 6.15 min), but that difference was not significant (P = 0.71). Conclusion: The drilling of facial recess is one of the most stressful steps during CI surgery, we recommend the use of UWD because of its good safety profile and protective measures.