A variety of congenital, traumatic, vascular, inflammatory, and neoplastic processes may affect the facial nerve. Prudent use of CT and MR imaging combined with a complete understanding of facial nerve anatomy helps in narrowing the differential diagnosis. The precise anatomic course of the facial nerve must be charted in patients who undergo middle ear surgery. Also of great importance is recognition of the fact that the facial nerve may be affected in cancers of the head and neck by perineural spread. This article reviews the anatomy of the facial nerve and relevant, current clinical evaluation and imaging strategies.