Petrous bone cholesteatoma and facial paralysis

Abstract

This paper describes a series of patients with a petrous temporal bone cholesteatoma paying particular attention to the complications and their management. Sixteen patients who underwent surgery in our department were reviewed. Topographically, the petrous bone cholesteatomas were grouped into five categories according to the classification proposed by Sanna et al. There were five massive labyrinthine; five infralabyrinthine; one apical; four supralabyrinthine; and one infralabyrinthine-apical. Clinically, the presenting symptom of these lesions were facial nerve paralysis (10 patients) and unilateral deafness (13 patients). Total removal of the cholesteatomas was achieved in all patients using different surgical approaches according to their site and extent. Recurrences were observed in two patients after 8 months and 24 months, respectively. The facial nerve was infiltrated and compressed by the cholesteatoma in eight patients. Seven were managed with cable grafts using sural nerve. One of these patients was treated using a facial-hypoglossal anastomosis because of the failure of the graft. In the remaining patient, a baby-sitter procedure was employed. In the other two patients, the preoperative facial paralysis was due to compression by the cholesteatoma, and its removal allowed partial recovery of facial function. The rationale of the surgical management of petrous bone cholesteatoma is its radical and total removal. Our present policy is to prefer approaches which result in a closed cavity obliterating the eustachian tube and closing the auditory canal as a blind sac. Facial nerve function is the main complication of these lesions, Facial nerve involvement requires rapid management because the duration of the paralysis is directly related to poor recovery of facial function.

Neuroradiology of Cholesteatomas

“…According to several studies, [28][29][30][31][32] middle ear cholesteatomas present with the following clinical signs:…”

Infantile congenital petrosal cholesteatoma: A case report and literature review

“…Hence, facial nerve paralysis tends to develop slowly, typically after middle age. The incidence of facial nerve paralysis has been reported to be 42.5% by Sanna et al [17] and 62.5% by Magliulo et al [18] The current case represents a rare instance in which facial nerve paralysis developed as the initial symptom, despite the relatively small size of the tumor and young age of the patient.…”

Extension of the Clinical Significance of the “Cog”

“…In fact, the 3-D relationship of the epitympanum, the attic, and its adjacent clinically anatomical structures (the facial nerve, the cochlea, the semicircular canals, and the skull base) is very intricate [9][10][11]. A good understanding of the surgery-related anatomical relationship between the epitympanum, the attic, and its adjacent anatomical structures is very helpful for the surgeon when removing all lesions within the epitympanum, the anterior epitympanum, and the attic.…”