The incidence of preoperative damage to the facial nerve in cochlear implantation is very low. The course of the facial nerve is not routinely evaluated preoperatively, but variations in its course can restrict access to the round window and impede implantation. In 5 of 42 operations, direct visualization of the round window was not possible. In 1 patient there was an obvious congenital bifurcation. Successful implantation was made possible by mobilizing the nerve.