Iatrogenic facial nerve injury during mastoidectomy poses a significant challenge in otologic surgery, given the nerve's intricate anatomy and critical functions. This case series highlights five instances of such injuries, managed through varied interventions including cable nerve grafting, facial nerve decompression, and conservative steroid therapy, with mixed outcomes ranging from complete recovery (House-Brackmann Grade II) to no improvement. The discussion emphasizes the importance of meticulous surgical techniques, intraoperative facial nerve monitoring, surgeon expertise, and preoperative imaging to mitigate risks. Immediate postoperative exploration is recommended if intraoperative nerve integrity is uncertain. Comprehensive rehabilitation and early intervention are crucial for optimizing recovery and minimizing psychological and economic burdens. This study underscores the need for continued advancements in preventive strategies, surgical training, and innovative technologies to enhance patient outcomes.