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Objectives : Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods : This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna's classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results : PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions : The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Objectives: To evaluate the incidence of facial canal dehiscence (FCD) and other intraoperative findings over the last 20 years as well as correlation with the Japanese Otological Society/European Academy of Otology and Neurotology classification in patients with cholesteatoma., Materials and Methods: A total of 469 patients operated from 1998 to 2018 were selected and divided into 2 groups of 10 years each., Results: Dehiscence was significantly higher in patients with a history of pathology longer than 5 years (22.7%). Higher values were observed in revision surgery, 44.4% in the first period and 41.7% in the second. The tympanic segment was the one most frequently involved, affecting 92% of patients in the first period and 97% of patients in the second. Dehiscence occurred significantly more often in patients with a semicircular canal fistula, 14.8% in the first decade and 8.8% in the second. The incidence of FCD was significantly higher in patients with primary cholesteatoma (especially in those with combined pars tensa-flaccida) than in those with a secondary acquired one, 31.5% vs 7.4% in the first period, 21.1% vs 7.4% in the second, and in those with a stage III disease, 42% in the first period, 33.3% in the second., Conclusion: Patients with a shorter history of cholesteatoma as well as those not previously operated had a lower incidence of FCD. The tympanic tract of the facial nerve remains the most frequent site of dehiscence, while the association between dehiscence and fistula of the semicircular canal remains strong. Patients with combined pars tensa-pars flaccida and stage III cholesteatoma have a higher incidence of FCD.

Objectives : Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods : This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna's classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results : PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions : The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes. [ABSTRACT FROM AUTHOR]

Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure. [ABSTRACT FROM AUTHOR]

the aim of this paper is to study the incidence of facial canal dehiscence (FCD) in pediatric and non-pediatric patients, analyzing eventual differences in frequency, localization, primary or revision surgery and duration of the disease. 527 patients suffering from chronic otitis media with acquired cholesteatoma, divided into two groups, those aged 18 years or over (470 patients), and those aged below 18 years (57 patients). Total incidence of FCD in adult population was 25,7% (121/470) and 7% (4/57) in pediatric one. Globally higher values were found in revision surgery, 43,5% (40/92) in adults and 16,7% (1/7) in children. Diseases longer than 5 years have been correlated to higher incidence of FCD in adults, 29,9% (109/364), than in pediatrics, 7,3% (3/41). No statistical significant difference has been found in those with a disease shorter than 5 years: 11,3% in adults (12/106) and 6,2% in children (1/16). The majority of patients, both adults and pediatrics, had a dehiscence in the tympanic tract of facial nerve. No statistical correlation regarding concomitant semicircular canal fistula and FCD has been found due to the absence of data in children. Incidence of FCD is higher in adult population than in pediatric. Adults have a higher incidence in primary surgery than children. No statistical significant difference has been found in adults and pediatrics with a less than 5 years disease, while diseases longer than 5 years expose adults to higher risk of FCD. Middle tract of tympanic segment is the most involved site of dehiscence in both populations. [ABSTRACT FROM AUTHOR]