ABSTRACT

Petrous apex cholesteatomas are cholesteatomas which are in the medial of otic capsule. In this case, 55 year old female who had facial paralysis and CSF otorrhea after radical mastoidectomy for petrous apex cholesteatoma is presented. The otoscopic examination of the patient who had undergone radical mastoidectomy 10 years ago, revealed that the cavity had smooth surface, ephitelized and healthy in appearance. On the tomography of the temporal bone, soft tissue density that eroded cochlea superiorly forming tegmen defect, showed intracranial extension from medial of the semicircular canals and surrounded internal auditory canal (IAC) superiorly, was observed. On the audiometric examination of the left ear, severe sensorineural hearing loss (SNHL) was detected. Subtotal petrosectomy was done due to cholesteatoma recurrence of supralabyrinthine-apical petrous bone. It was understood that cholesteatoma matrix originated from supralabyrinthine cells located in the superior of the cochlea. It was observed that cholesteatoma accompanied superior petrosal sinus between dura and partially destructed petrosal bone and on the medial of superior semisurculer canal. After subtotal petrosectomy, cavity was obliterated with adipose tissue and the external ear canal was terminated as a blind pouch. Postoperative complications were not observed and the patient was discharged uneventfully. In the first postoperative year, on the control diffusion magnetic resonance (MR), recurrent lesion was not observed. The case was admitted to the clinic because of CSF otorrhea which has not been reported in the literature before. Cholesteatoma unleading to destruction of soft tissue reached İAC, eroded the bone to which dura leaf was attached, and this erosion leaded to otorrhea. It is very difficult to separate cholesteatoma from dura completely and is a major reason for relapse. Therefore, cavity obliteration is controversial. Although open cavity is recommended for a possible recurrence, in this case, obliteration was done due to the risk of CSF otorrhea and infection.