Giant cholesteatoma presenting as a postauricular mass

Share Embed

Descrição do Produto

Giant cholesteatoma presenting as a postauricular mass ILHAN TOPALOGLU,MD, MUSTAFAZAFERUGUZ, MD, FAZILNECDETARDI(~, MO, Izmir, Turkey

C h o l e s t e a t o m a is a three-dimensional epidermoid structure exhibiting independent growth, replacing the middle ear mucosa, resorbing underlying bone, and tending to recur after removal. 1 Cholesteatoma rarely extends beyond the tympanomastoid space, but when the lesion is aggressive, it can extensively erode the temporal bone. In this article we report on a giant cholesteatoma that eroded and exteriorized through the mastoid cortical bone.

CASE REPORT A 26-year-old woman with left hemifacial spasm had a postauricular mass, hearing loss, and discharge from the left ear. The patient had a history of aural drainage during childhood, and in the years before she was seen by a physician, a postauricular fistula, complete loss of hearing on the left side, and a left hemifacial spasm developed. The following year she noted a retroauricular mass. On physical examination of the head and neck, there was a soft, light gray, nontender, 6 x 3 cm mass at the retroauricular region and a 1 x 1 cm red polypoid structure 1 cm superior to the auricle (Fig. 1). Desquamated keratin lamellae were seen on the surface of the huge mass. There was a large central perforation in the right tympanic membrane, but on the left side a mass obliterating the left external meatus was present. The patient underwent CT scan of the temporal bone, which showed a necrotic soft tissue mass obliterating the external ear, middle ear, and mastoid air cells. It destroyed the temporal bone cortex through two sepa-

From the First Department of Otolaryngology and Head Neck Surgery Clinic of izmir Atatiirk State Hospital. Reprint requests: Ilhan Topalo~lu, MD, Hasan Tahsin cad. Fatma Hanim, Apt. no. 178/9, 35360 Basin Sites~zmir, Turkey. Otolaryngol Head Neck Surg 1997;116:678-9. Copyright © 1997 by the American Academy of OtolaryngologyHead and Neck SurgeryFoundation, Inc. 0194-5998/97/$5.00 + 0 23/4/72856 678

rate locations (Fig. 2). The tegmen tympani and tegmen antri, posterior bony wall of the vestibule, semicircular canals, and posterior wall of the internal acoustic canal were eroded. On pure-tone audiometry, a mean of 43 dB conductive hearing loss in the right ear was found, and the left ear was anacoustic. Comparison of the left side with the normal side by facial electroneurography showed an amplitude ratio of 35%. After surgery a wedge biopsy from the retroauricular mass showed cholesteatoma and inflammatory granulation tissue. Left extended radical mastoidectomy and aural mass extirpation, including retroauricular ulcerative skin and bone, were performed in March 1993. At operation it was seen that the cortex of the temporal bone, posterior wall of the meatus acousticus externus, tegmen antri, tegmen tympani, semicircular canals, and horizontal and vertical parts of the fallopian canal were eroded by the cholesteatoma. There was no dural erosion or cerebrospinal fluid leakage. After the cholesteatoma was totally removed, the large defect was filled with nitrofurazon-impregnated gauze strips. The histopathologic

Fig. I. Retroauricular mass a n d little p o l y p l o i d structure before surgery.

OtolaryngologyHead and Neck Surgery

TOPALOGLU et al. 679

Volume 116 Number 6 Part 1


Although epidermoid cholesteatoma is not a neoplasm, it shows the ability to destroy adjacent tissues, particularly bone. In our patient cholesteatoma eroded the ossicular chain, the semicircular canals, and the fallopian canal, but there was no extensive erosion of the cochlea. Interestingly, cholesteatoma had become apparent in the postauricular region because of erosion of the temporal bone cortex. The sternocleidomastoid myocutaneous flap that we used during the operation not only obliterated the skin defect but also decreased the volume of the cavity with its bulky structure. Extension of aural cholesteatoma through the temporal bone cortex is unusual but has been reported in the middle fossa and posterior fossa. 2-4 This case is a good example of the invasive character of cholesteatoma and shows us that it can extend beyond the confines of temporal bone if it is untreated. Fig. 2. Preoperative CT scan demonstrating extensive b o n e destruction and extension of the mass.

examination revealed cholesteatoma and inflammatory polyps. The retroauricular defect was reconstructed 3 weeks later with a sternocleidomastoid myocutaneus flap. Otomicroscopic follow-up of the patient was performed, and control CTs were taken in November 1993 and November 1994. The patient, who had no problem with her cavity, has been coming for regular control visits.

REFERENCES 1. McCabe BF, Sade J, Abramson M. Summary reports on National-International Conferences. First International Conference on Cholesteatoma. Ann Otol Rhinol Laryngol 1976;85:844-5. 2. Atlas MD, Moffat DA, Hardy DG. Petrous apex cholesteatoma: diagnostic and treatment dilemmas. Laryngoscope 1992;102:1363-8. 3. Borgstein J, Martin F, SodaA. Giant congenital cholesteatoma. Ann Otol Rhinol Laryngol 1993;102:646-7. 4. ArkinCF, Millard M, Medeiros J. Giant invasive cholesteatoma. Arch Pathol Lab Med 1985;109:960-1.

Lihat lebih banyak...


Copyright © 2017 DADOSPDF Inc.