During a modified radical mastoidectomy for cholesteatoma, the surgeon encounters a dehiscent facial nerve at the second genu. The nerve is stretched over the cholesteatoma matrix. The most appropriate intraoperative action is:

• A Remove the matrix overlying the nerve en bloc to achieve complete clearance
• B Section the nerve and perform primary reanastomosis
• C Perform immediate sural nerve cable graft
• D Leave a thin layer of matrix on the nerve surface and plan staged revision ✓

Explanation

When the facial nerve is dehiscent and covered by cholesteatoma matrix, attempting complete en bloc removal risks causing iatrogenic facial palsy. The standard practice is to leave the innermost layer of matrix on the exposed nerve and plan a staged second-look procedure 6–12 months later to assess residual disease. Primary reanastomosis or cable grafting would only be relevant if the nerve were inadvertently sectioned, which is not the case here.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.