OBJECTIVE This study aimed to determine those patients who have sustained a facial nerve injury during surgery for congenital aural atresia and pinpoint the site of injury vis-a-vis the operative approach. METHODS The study design was a retrospective review of >1,000 patients undergoing atresia repair. METHODS The study was performed at a tertiary referral center. METHODS The study consists of 10 patients with a facial nerve injury from atresia surgery. METHODS In 1 of 10 patients, the facial nerve was transected. This occurred during the skin incision at the level of the helix. A sural nerve cable graft was used to repair the severed nerve. METHODS High-resolution computed tomography of the temporal bone was the most important preoperative study. However, in cases of aural stenosis with cholesteatoma, the course of the facial nerve may be camouflaged. RESULTS Ten of >1,000 patients operated on sustained a facial nerve injury from atresia surgery. Seven of these patients were those of the authors, whereas three had the initial surgery elsewhere, each by a different surgeon. CONCLUSIONS For the inexperienced surgeon, the facial nerve is at its greatest risk in the inferoposterior portion of atretic bone just lateral to the middle ear. For the experienced surgeon, the facial nerve is at its greatest risk in those patients with low-set ears, canal stenosis, and an accompanying cholesteatoma.