The risk of facial nerve injury during mastoid surgery has decreased substantially since the advent of the microscope and the otological drill. However, the facial nerve remains at risk during mastoid surgery with the present day incidence suggested to be one per cent. Despite the severity of this complication there are no recent studies that accurately quantify the incidence or discuss its management. The aims of this study were to identify the risk of facial nerve injury for both the specialist as well as the trainee specialist and to review a management protocol for this complication. During the 10-year period from 1985 to 1994, 1024 consecutive mastoidectomies were reviewed. A total of 17 palsies was identified, seven were complete and 10 were incomplete. Of the seven complete palsies, four patients had decompression only and recovered to House Brackmann Grade 2 or better while three patients had decompression and grafting, of these, two were available for follow-up and recovered to House Brackmann Grade 4 only. All the partial palsies, barring one lost to follow-up, who were treated conservatively with pack removal, toilet and topical therapy recovered to House Brackmann Grade 2 or better. A management protocol followed for the above patients is presented and the results analysed. Specific operations and manoeuvres which may put the facial nerve at risk intra-operatively are also discussed.