Objective: The aim of this study was to define the normal anatomical variation of the course of the CTN through the mastoid temporal bone on high resolution CT (HRCT).

Materials and methods: Retrospective review of 27 consecutive normal HRCT bilateral temporal bones (n = 54, 14 males and 13 females, mean age 41 years) reconstructed at 0.4-mm slice thickness specifically measuring (1) origin of CTN from the posterior genu of the facial nerve (CNVII) and (2) the lateral-most position of the CTN from the mastoid segment of CNVII.

Results: The mean distance of the CTN origin from the mastoid segment of CNVII was 11.5 mm (standard deviation, SD = 3.2, 95 % CI 10.7–12.3) with no statistically significant difference between the left and right side observed (p = 0.08). The most lateral distance of the CTN from CNVII was a mean of 1.3 mm (SD = 0.6, 95 % CI 1.2–1.7), range 0–2.5 mm and again no statistical significance between contralateral sides was observed (p = 0.11). These measurements demonstrated an excellent level of agreement between observers as assessed by intraclass correlation calculation.

Conclusions: Reproducible measurements demonstrate variability of the CTN in both its origin from the mastoid segment of CNVII and its lateral-most course. Precise description of the course of the CTN with HRCT may be useful for planning of otologic surgery and limiting inadvertent nerve injury.