Conclusions. Vestibulotomy above a severely displaced facial nerve represents a new surgical approach to achieve serviceable hearing. The lack of facial nerve injury and the potential for hearing restoration make this procedure feasible in patients who would otherwise be marginal or poor surgical candidates. Objective. To investigate the feasibility of vestibulotomy above a severely displaced facial nerve. Material and methods. Eight patients with severe congenital conductive hearing loss underwent vestibulotomy above a severely displaced facial nerve and hearing reconstruction between January 2000 and January 2002. All patients had congenital middle ear deformities. The facial nerves overhung and concealed the oval window niche or lay inferior to the oval window. The facial nerves were transposed in order to reach the oval window niche in four of eight cases. Results. Hearing gain was 15 dB in 2 ears, 16 - 25 dB in 3 and > 26 dB in 3. There were no cases of postoperative facial paresis.