Segment Of Facial Nerve Research Articles

Commentary: Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study.

Background Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined. Objective To analyze the effect of facial nerve segment involvement on functional outcome for these tumors. Methods Patients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function. Results A total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0 ± 2.4 cm3 and 12.2 ± 0.54 Gy, respectively. Mean radiological follow-up was 45.5 ± 38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P = .04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P = .03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2 patients). Conclusion SRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.

Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study.

Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined. To analyze the effect of facial nerve segment involvement on functional outcome for these tumors. Patients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function. A total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0± 2.4cm3 and 12.2±0.54Gy, respectively. Mean radiological follow-up was 45.5±38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P=.04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P=.03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2patients). SRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.

A Case of Cochlear Implantation in a Child with Congenital Aural Atresia and Cochlear and Cochlear Nerve Malformation

Congenital aural atresia (CAA) is usually accompanied by an anomalous course of facial nerves, which may run over the round window niche toward the promontory in some cases of CAA. Very rarely, cochlear malformation might coexist at the same ear which has CAA, in which case cochlear implantation can be difficult due to anomalous facial nerve. Herein we present a case of cochlear implantation performed in a child who had CAA along with cochlear hypoplasia and cochlear nerve aplasia. The mastoid segment of facial nerve was displaced anteriorly, running over the round window niche. The surgery was done successfully using the round window approach without facial nerve injury.

Segment-Based Methods for Facial Attribute Detection from Partial Faces

State-of-the-art methods of attribute detection from faces almost always assume the presence of a full, unoccluded face. Hence, their performance degrades for partially visible and occluded faces. In this paper, we introduce SPLITFACE, a deep convolutional neural network-based method that is explicitly designed to perform attribute detection in partially occluded faces. Taking several facial segments and the full face as input, the proposed method takes a data driven approach to determine which attributes are localized in which facial segments. The unique architecture of the network allows each attribute to be predicted by multiple segments, which permits the implementation of committee machine techniques for combining local and global decisions to boost performance. With access to segment-based predictions, SPLITFACE can predict well those attributes which are localized in the visible parts of the face, without having to rely on the presence of the whole face. We use the CelebA and LFWA facial attribute datasets for standard evaluations. We also modify both datasets, to occlude the faces, so that we can evaluate the performance of attribute detection algorithms on partial faces. Our evaluation shows that SPLITFACE significantly outperforms other recent methods especially for partial faces.

Application of 3D U-net in automatic segmentation of middle ear surgery structures in temporal bone CT

Objective:To study the feasibility of fully automatic segmentation of labyrinth, facial nerve and ossicles in clinical routine temporal bone CT images based on 3D U-net neural network. Method:Clinical data were divided into two groups: ①Normal group: data were randomly assigned from 30 patients for routine temporal bone CT examination; ②Abnormal group: cochlear, ossicles and facial nerve morphology variation of 1 case each. The structures of facial nerve, labyrinth and ossicles were manually initial segmented and fine segmented by 2 clinicians with Mimics 20.0. Three-dimensional convolutional neural network（3D U-Net） was selected to conduct deep learning on the same data. The dice similarity coefficient（DSC） was used as the evaluation index. Result:The 3D U-net neural network was used to automatically segment the labyrinth, ossicles and facial nerve in the routine temporal bone CT. In the normal group, the DSC of labyrinth, ossicles and facial nerve were 0.79±0.03, 0.64±0.05 and 0.49±0.09, respectively. In the abnormal group, the DSC of these structures were 0.71, 0.54 and 0.40. Conclusion:According to the anatomical characteristics of the temporal bone, the labyrinth, ossicles and the facial nerve can be totally automatic segmented by 3D U-net neural network, and the accuracy was closed to that of manual segmentation. This method is feasible, fast and accurate.

Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging in Bell's palsy.

Bell's palsy (BP) is the most common form of acute facial nerve disorder and is characterized by rapid onset peripheral facial palsy of unknown etiology. To explore the diagnostic value of dynamic contrast-enhanced (DCE) magnetic resonance imagine (MRI) in patients with BP particularly in involved segments. A retrospective analysis was performed on the patients with BP who underwent routine MRI examinations and volumetric interpolated breath-hold examination (VIBE) sequence-based DCE-MRI before surgery in our department from January 2015 to July 2020. DCE-MRI data postprocessing was performed on Siemens Workstation Extended MR Work Space 2.6.3.5. Statistical analyses were performed using SPSS®v.19.0. The inter-observer reliability was evaluated with kappa identity test and McNemar's test. Twenty-three patients were included. On conventional contrast-enhanced MRI, the two observers were inconsistent in their diagnosis of lesion segments of facial nerve (Kappa 0.426, P = 0.009). Compared to the results of the surgery, the diagnostic consistency of both observers was general (Kappa 0.476, P < 0.001 and Kappa 0.430, P < 0.001, respectively). The diagnostic results of DCE-MRI for lesion segments of the facial nerve were consistent between the two observers (Kappa 0.929, P < 0.001). Compared to the results of the surgery, the diagnostic consistency of both observers was good (Kappa 0.753, P < 0.001 and Kappa 0.731, P < 0.001, respectively). Compared to conventional MRI, DCE-MRI has good stability and repeatability in the diagnosis of the lesion segments of the facial nerve as well as a good specificity and accuracy.

Our Experience of Anatomical Variations of Facial Nerve in Cadaveric Temporal Bone Dissection.

Cadaveric dissections helps aspiring ear surgeon to learn anatomy of temporal bone so as to avoid injury to the many vital structures. Objectives are to study the course of facial nerve and its variation in 50 cases of temporal bone dissection. To study the various parameter of the tympanomastoid segments of facial nerve, its relation with the important middle ear structures and their variations. To study the incidence of anatomical variations such as dehiscence of bony canal of facial nerve, bony overhang in the oval window region. The Current study was conducted at Dept. of ENT Temporal bone lab. 50 temporal bones were dissected to study the various parameters of the tympano-mastoid segments of the facial nerve, its relations with the important middle ear structures and their anomalies. The present study was carried out from Jan 2016 to Jan 2019. Out of 50 bones dissected, 44 (88%) bones were well pneumatised and 6(12%) bones were sclerotic. Length of the tympanic segment varied from 7.8 to 11.88mm with a mean of 9.47mm (± 1.06mm). In 17 bones (34%) length of the mastoid segment was 13.1-14mm, in 12 bones (24%) the length was 14.1-15mm, while in 10 bones (20%) it was 12-13mm. In 6 bones (12%) it was 15.1-16mm and < 12mm in 5 other bones (10%). The distance of second genu from outer cortex varied from 17.87-23.67mm with a mean of 19.64mm (± 1.42mm).Distance of chorda tympani from stylomastoid foramina varied from 3.4-7.8mm with a mean of 5.69mm (± 1.51mm). The study has provided knowledge of anatomy of temporal bone and its pneumatization pattern, the anatomy of the facial nerve, its variations and their incidence, relation of various middle ear landmarks with the facial nerve and proficiency in dissection.

Invasion Patterns of External Auditory Canal Squamous Cell Carcinoma: A Histopathology Study.

To describe the histopathology of the invasion patterns of advanced-stage external auditory canal (EAC) squamous cell carcinoma (SCC). Study Design Retrospective cohort study. Retrospective analysis of medical records of patients diagnosed with EAC SCC available at the Massachusetts Eye and Ear temporal bone (TB) collection. TBs underwent processing for histologic examination. Hematoxylin and eosin-stained slides were examined. Histologic findings were compared to premortem clinical data. Nine TBs were identified. Male:female ratio was 6:3. The average age of diagnosis and duration of survival was 64 (46-80 years) and 2.3 years (1-50 months), respectively. All presented with T4 disease, most commonly due to petrous apex (PA) invasion and facial nerve (FN) weakness. The mastoid air cells system served as a tumor conduit to the tegmen mastoideum and overlying dura in four patients, posterior fossa dura in one patient, vertical segment of FN in four patients, and middle ear (ME) and lateral semicircular canal in five patients. The tumor did not penetrate the tympanic membrane, oval window membrane (fenestra vestibule), or round window (RW) membrane. Supra- and infralabyrinthine pneumatization patterns allowed direct routes to the PA. Translabyrinthine PA invasion was seen in two patients. The most common locus of otic capsule invasion was the cochlea. One patient had FN paralysis due to compression rather than invasion. SCC does not tend to extend from the ME to the inner ear through the RW and vestibule-stapedial ligament. Tumors tend to spread along the preexisting TB air-tract routes. Well-aerated TB, may facilitate extension to the PA. 4 Laryngoscope, 131:E590-E597, 2021.

Congenital duplication of mastoid segment of facial nerve in child candidate for Cochlear Implantation Surgery: a rare case report.

Congenital duplication of mastoid segment of facial nerve in child candidate for Cochlear Implantation Surgery: a rare case report.

Congenital duplication of mastoid segment of facial nerve in child candidate for Cochlear Implantation Surgery: a rare case report

Congenital duplication of mastoid segment of facial nerve in child candidate for Cochlear Implantation Surgery: a rare case report

Facial Schwannoma Management Outcomes: A Systematic Review of the Literature.

To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address controversies in management. PubMed-National Center for Biotechnology Information and Scopus databases. A systematic review of the literature was performed for studies regarding facial schwannomas. Studies were included if they presented patient-level data, type of intervention, pre- and postintervention House-Brackmann (HB) grades, and tumor location by facial nerve segment. Individualized data from 487 patients were collected from 31 studies. Eighty (16.4%) facial schwannomas were managed with observation, 25 (5.1%) with surgical decompression, 20 (4.1%) with stereotactic radiosurgery, 225 (46.2%) with total resection, and 137 (28.1%) with subtotal resection/stripping surgery. Stripping surgery/subtotal resection with good preoperative facial nerve function maintained HB grade 1 or 2 in 96% of cases. With a total resection of intradural tumors, preoperative HB grade did not significantly affect facial nerve outcome (n = 45, P = .46). However, a lower preoperative HB grade was associated with a better facial nerve outcome with intratemporal tumors (n = 56, P = .009). When stereotactic radiosurgery was performed, 40% of patients had improved, 35% were stable, and 25% had worsened facial function. Facial nerve decompression rarely affected short-term facial nerve status. The data from this study help delineate which treatment strategies are best in which clinical scenarios. The findings can be used to develop a more definitive management algorithm for this complicated pathology.

Classification of affect states from facial segments using transfer learning

Classification of affect states from facial segments using transfer learning

Role of High-Resolution CT and MRI in Predicting the Degree of Difficulty in Patients undergoing Cochlear Implant Surgery: An Institutional Experience

Abstract Introduction Preoperative imaging is a standard practice for cochlear implant candidacy. We are discussing association between surgical feasibility and various anatomical details of middle and inner ear by both high-resolution computed tomography (HRCT) and 3T magnetic resonance imaging (MRI) in patients with bilateral sensorineural hearing loss (SNHL) and are used as a guide during surgery as well as foresee complications in cochlear implantation. Materials and Methods A total of 56 patients of aged 1 to 5 years (prelingual) and &gt; 1 years (postlingual or perilingual) having bilateral SNHL were included in the study. HRCT temporal bone and MRI head was done in all candidates. Based on the imaging findings of CT and MRI, patients were divided into two categories (normal and abnormal). Demographic and clinical values were compared between two groups. Binary logistic regression analysis was used to identify the predictors of the outcome variable (surgical difficulty). Results Out of 56 patients, 55 underwent cochlear implantation by Veria technique, one patient having Michel’s deformity was denied surgery and was advised brain stem implant. Note that 69.1% patients had no radiological abnormality, while 30.9% patients showed abnormality including acquired disease and malformation. Out of the total study patients, 18% (n = 10) showed various type of congenital inner ear malformation. Large size of the external auditory canal (EAC), high basal turn angle (BTA), and increased distance between tympanic segment of facial canal to EAC (midpoint between level of I-S joint corresponding to EAC and exit of chordae tympanic at level of EAC), all these factors showed inverse relationship with difficulty in surgery, which were found to be statistically significant. Conclusion The imaging in cochlear implant patients is an essential tool for preoperative assessment of candidacy, surgical planning, and avoid intra- and postoperative complications. BTA and distance between tympanic segment of facial nerve and EAC (midpoint between level of I-S joint corresponding to EAC and exit of chordae tympanic at level of EAC) are important predictors for evaluating intra- and postoperative complications.

Differences in Facial Expressions between Spontaneous and Posed Smiles: Automated Method by Action Units and Three-Dimensional Facial Landmarks.

Research on emotion recognition from facial expressions has found evidence of different muscle movements between genuine and posed smiles. To further confirm discrete movement intensities of each facial segment, we explored differences in facial expressions between spontaneous and posed smiles with three-dimensional facial landmarks. Advanced machine analysis was adopted to measure changes in the dynamics of 68 segmented facial regions. A total of 57 normal adults (19 men, 38 women) who displayed adequate posed and spontaneous facial expressions for happiness were included in the analyses. The results indicate that spontaneous smiles have higher intensities for upper face than lower face. On the other hand, posed smiles showed higher intensities in the lower part of the face. Furthermore, the 3D facial landmark technique revealed that the left eyebrow displayed stronger intensity during spontaneous smiles than the right eyebrow. These findings suggest a potential application of landmark based emotion recognition that spontaneous smiles can be distinguished from posed smiles via measuring relative intensities between the upper and lower face with a focus on left-sided asymmetry in the upper region.

Transcanal Endoscopic Approach to the Mastoid Segment of Facial Nerve and the Role of the Pyramidal Eminence as a Landmark

Objectives: To study the feasibility of approaches in addressing the mastoid segment of facial nerve through transcanal route exclusively under endoscopic guidance and to verify the usefulness of the pyramidal eminence as a landmark.&#x0D; Study design: The prospective experimental study&#x0D; Setting: “Transcanal endoscopic temporal bone dissection lab” situated in the Surgiscope hospital, Chittagong, Bangladesh.&#x0D; Materials: 4 (Four) cadaveric temporal bones.&#x0D; Interventions: Two pure transcanal endoscopic approaches were applied to excavate the mastoid segment of facial nerve. In anterior-medial approach, the dissection was progressed from medial to the lateral direction through the retrotympanum focusing the anterior-medial side of the mastoid segment of facial nerve. Whereas in anterior-lateral approach, the dissection was progressed from lateral to the medial direction through the posterior canal wall focusing the anterior-lateral side of the mastoid segment of facial nerve. In both approaches, the pyramidal eminence was considered as an anatomical landmark to navigate the dissection for the excavation of the mastoid segment of facial nerve.&#x0D; Main outcome measures: The efficacy of each approach in respect of the complete excavation of the mastoid segment of facial nerve and the worthiness of the pyramidal eminence as the landmark for navigating the dissection.&#x0D; Results: In both transcanal endoscopic approaches, the entire mastoid segment of facial nerve could be exposed successfully. But in anterior-medial approach, the chorda tympani nerve was needed to be sacrificed. The search of the mastoid segment of facial nerve with the guidance of the pyramidal eminence was observed as effective and safe.&#x0D; Conclusion: The entire mastoid segment of facial nerve could be successfully addressed through transcanal route under pure endoscopic guidance. The pyramidal eminence has appeared as an important landmark for such endeavor.&#x0D; Bangladesh J Otorhinolaryngol; October 2019; 25(2): 108-115

The effect of tooth wear, age and sex on facial height assessed by soft tissue analysis.

The aim of the study was to evaluate the effects of tooth wear, age and sex on facial height measurements based on soft tissue analysis. One hundred and twelve subjects (45 males and 67 females), 19-80years of age (mean 43±0.9years), which were divided into three age groups, met the inclusion criteria. Tooth wear was assessed using a 5-point ordinal scale (0-4). Based on the tooth wear score, three groups were defined: mild, moderate and severe wear. Facial height was evaluated based on soft tissue measurements using frontal facial photographs. The dimension of the upper facial height (UFH) and lower facial height (LFH) and the ratio between the two (R-U-L) were measured. Facial height dimensions (UFH, LFH) were significantly different between the three age groups and between the three tooth wear groups. Both the UFH and LFH measurements had a weak positive correlation with age (r=.40; r=.41, respectively) and with tooth wear (r=.40; r=.41, respectively). The R-U-L showed a significant difference (P<.001) between sexes as males showed slightly lower ratio compared with females; however, the R-U-L was not dependent upon age or tooth wear. This study demonstrated that although facial height is affected by age and tooth wear, the proportion between the upper to lower facial segments is constant and is not affected by the same parameters. A statistically significant difference in the R-U-L relative to sexes was noted.

Polytetrafluoroethylene granuloma-associated facial palsy following microvascular decompression.

Microvascular decompression (MVD) may be employed in the management of hemifacial spasm (HFS), wherein a pledget of polytetrafluoroethylene (i.e., Teflon, Chemours, Wilmington DE) is sometimes introduced to separate an offending vessel from the cisternal segment of facial nerve. Rarely, Teflon may cause a granulomatous reaction resulting in nerve palsy. We here present the first case series of facial palsy thought to be secondary to Teflon granuloma following MVD for HFS. A data repository of 1,312 patients with facial palsy was reviewed to identify individuals who had previously undergone MVD for HFS. Data collected include age at time of MVD, age at onset of facial weakness and at presentation, House-Brackmann scores, clinician-graded facial function using the Electronic Facial Paralysis Assessment scale, imaging findings, and therapeutic interventions and outcomes. Six patients meeting criteria were identified. Average time between MVD with Teflon placement and onset of facial weakness was 16.1 (±4.9) years (range 9.3-23.3 years). Initial House-Brackmann scores were as follows: four patients with V/VI and one each with III/VI and IV/VI. Interventions included eyelid weight placement (n = 3), chemodenervation (n = 2), static suspension with tensor fascia latae (n = 2), dynamic reanimation with cranial nerves V to VII transfer (n = 1), and temporalis muscle transfer (n = 1). Teflon granuloma should be considered in the differential diagnosis for patients presenting with new onset facial weakness with a previous history of MVD for HFS. It remains unknown whether early granuloma extirpation is effective. Prompt diagnosis allows consideration of time-sensitive nerve transfer procedures to reanimate facial function. 4 Laryngoscope, 130:1422-1427, 2020.

Characteristic patterns of segmental infantile hemangiomas in Indian children: A descriptive study.

Approximately 18% of infantile hemangiomas are segmental. These are larger than other infantile hemangiomas, associated with higher rate of complications and developmental anomalies, and often require treatment. They follow nonrandom patterns on the head and neck as well as extremities which are probably related to embryologic development. Our study aimed to describe segmental patterns of infantile hemangiomas in Indian children, with associated anatomical abnormalities if any. Over a 9-year period, 59 infants presenting with lesions classified as segmental infantile hemangiomas were evaluated and analyzed. Associated developmental anomalies were assessed and recorded. In addition, patterns of "indeterminate" infantile hemangiomas in another 43 patients were analyzed. There were 14 male and 45 female infants with an average birth weight of 2.7 ± 0.726 kg in our study; the average age at onset was 1 ± 1.25 months with most (50.8%) lesions localized to the head and neck area. Mapping of lesions showed that the most common facial segments involved were mandibular (33%) and maxillary (30%). However, additional repetitive patterns not previously described (such as an "inverted comma" pattern on the chest, bilateral neck involvement and unilateral labium involvement) were seen in our patients. Common local complications were ulceration (27%), amblyopia and nasal obstruction (3% each). Mapping of the additional 43 patients with indeterminate infantile hemangiomas also showed repetitive though incomplete patterns. Relatively small number of patients. Segmental infantile hemangiomas present as large, distinctively patterned lesions, even on the trunk and genitalia. These patterns are probably based on embryologic developmental patterns. In addition, indeterminate lesions also showed distinctive repetitive patterns. Our study suggests that additional segments may need to be defined, particularly on the trunk and genital area.

A Case of Congenital Bifurcation of the Labyrinthine Segment of Facial Nerve

The most common anomaly of facial nerve is bony dehiscence of the fallopian canal, being present in approximately 55% of the population. Abnormal courses of facial nerve are reported commonly. Of the malformation of the facial nerve, bifurcation of its intratemporal portion has been rarely reported, in which one or more segments of the facial nerve splits. Nine years-old girl (right-handed) came to our outpatient clinic for left hearing loss, which was incidentally found by herself. Audiologic and radiologic work-up demonstrated unilateral sensorineural hearing loss, which was resulted from the narrow bony cochlear nerve canal, and incidentally found the bifurcation of the labyrinthine segment of ipsilateral facial nerve. We described characteristic findings on the computed tomogram of this anomaly and discussed it. It is important to identify the anomalous facial nerve in the patients undergoing evaluation for congenital hearing loss. (J Clinical Otolaryngol 2019;30:83-87)

A Clinico-Radiological Study: Veria Technique of Cochlear Implant-A Study of 50 Cases.

Main limitation of classical technique is limited access to cochlea in terms of cochlear rotations and related structures, thus causing difficulty in electrode insertion. Veria technique allows full access to cochlea after raising tympanomeatal flap. To our best knowledge this is first clinic-radiological study for Veria technique studying distance between tympanic segment of facial nerve and posterior wall of external auditory canal (EAC) demonstrating facial nerve safety. Prospective study was done on 50 patients having bilateral sensori-neural hearing loss. Patients underwent cochlear implant surgery irrespective of age and gender. Preoperative high-resolution computed tomography temporal bone and magnetic resonance imaging head was done, distance between tympanic segment of facial nerve and posterior wall of EAC and basal turn angle were measured. Intraoperative NRT followed by orbito-meatal X-ray was done in post operative period. 25 (50%) were male, 25 (50%) female. 35 patients (70%) showed that the distance between tympanic segment of facial nerve and posterior wall of EAC was more than 3mm with mean 4.41mm (± 0.63 SD). Distance calculated was greater in older age group than younger group. Patient having inner ear malformation, mean was 3.96mm (± .44 SD). Whereas patients having acquired disease, mean distance was 4.30mm (± .47 SD). On gender comparison of basal turn angle score, no significant difference was observed male (54.34° ± 4.48°) versus female (55.66° ± 4.15°) (p = 0.282). Mean of basal turn angle (BTA) in ≤ 5years age group was 54.89° ± 3.65°, in 6-10years age group was 55.21° ± 5.23° and in age group ≥ 11years was 54.93° ± 4° with no significant difference in mean value between the groups (p = 0.282). High jugular bulb was seen in 4 patients (2 in right side, 2 in left side), hypoplastic jugular bulb was seen in 10 patients (9 in left, 1 in right), otosclerosis in 2 patients. Veria technique is safe for facial nerve, as preoperatively distance between tympanic segment of facial nerve and posterior canal wall can be identified. It is suitable method for rotated cochlea (identified preoperatively through BTA) and deformed cochlea as it offers a wide visibility and accessibility as compared to posterior tympanotomy approach. BTA and distance between posterior canal wall of EAC and tympanic segment of facial nerve should be done in all cases to see any cochlear rotation and feasibility of surgery.