Management of the Facial Nerve in Complex Cases of Petrous Apex Cholesteatoma: Case Report

Management of the Facial Nerve in Complex Cases of Petrous Apex Cholesteatoma: Case Report

Congenital cholesteatoma in the petrous apex grows insidiously and causes profound sensorineural hearing loss, vertigo, and/or facial nerve paralysis. Although the goal of treatment of petrous apex cholesteatoma (PAC) is its complete removal, total removal followed by obliteration is often difficult because of the extent of cholesteatoma invasion and/or the anatomical complexity of the petrous apex. In complex cases with encasement of vital structures such as the internal carotid artery (ICA), sigmoid sinus, and jugular bulb and/or with further extension to the clivus, sphenoid sinus, or nasopharynx, control and management may be even more difficult. In this paper, three cases of complex PAC are presented and their optimum surgical treatment is discussed in detail, particularly management of the facial nerve in cases of PAC.