Objective To reconstruct the main sections of the facial nerve recess approach using double oblique multi-planer in multi-slice CT. Methods According to the normal surgical procedure of facial nerve recess approach, the temporal bone was dissected to expose main operative sections and anatomic marks. Images of the main operative sections from 80 patients (55 adults and 25 children) without abnormality in the temporal bone were reconstructed using double oblique muttiplaner reconstruction in muilti-slice CT. The achievement ratio was calculated. The differences among the transverse，coronal，and sagittal planes and double oblique planes were compared. The relationship with adjacent structures was measured. The appearances in different images and age groups were compared. Results Four key operative sections were involved in the facial nerve recess approach and their orientations were of oblique sagittal. Landmarks of the four key operative sections displayed on the double-oblique imaging rather than on transverse, coronal and sagittal planes. The achievement ratio of every section was 100%. The vertical distance between the central point of superior margin of horizontal semicircular canal and the bony wall of the middle cranial fossa in children was shorter than that in adults (EM>P/EM> <0.05). The vertical distance between the sigmoid sinus and posterior wall of the external auditory canal in children was shorter than that in adults (EM>P /EM><0.05). No significant difference in the distance between the inferior border of the tympanic segment and the inferior margin of the oval window was found between the age groups (EM>P /EM>>0.05). The vertical distance between the anterior margin of the mastoid segment and posterior external border of round window was not statistically different between the age groups (EM>P/EM> >0.05). Conclusion Double oblique multi-planar reformation is a new method to demonstrate landmarks of operative sections of the facial nerve recess approach in one slice. In combination with the operative approach and purpose, the reconstructive images of the operative section with double oblique multi-planer reconstruction may provid