Postoperative efficacy analysis of patients with facial nerve palsy associated with cholesteatoma otitis media: Our experience with 32 patients

A case of congenital cholesteatoma in adult patient with intermittent episodes of facial palsy

INTRODUCTION AND IMPORTANCE

Congenital cholesteatoma is a rare entity that arises from epithelial cell rests in the middle ear, parts of temporal bone or even intracranially. However, it can go unrecognized for several years making the consideration of such diagnosis a bit tricky among otologists.

CASE PRESENTATION

We are reporting a case of a young female adult who presented with unilateral hearing loss for one year and intermittent episodes of facial twitching in addition to periods of recurrent unilateral facial palsy that happened about three times in the past two years.

CLINICAL DISCUSSION

Otoscopic examination revealed a slight whitish mass behind the superior half of an intact tympanic membrane. High-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) proposed a differential diagnosis of congenital cholesteatoma and facial schwannoma. Canal wall up (CWU) mastoidectomy with exploration of anterior epitympanum and partial facial nerve decompression was made with complete removal of cholesteatoma mass and ossicular reconstruction.

CONCLUSION

A recurrent or non-resolving facial asymmetry in an otherwise healthy adult should raise the suspicion among otolaryngologists to investigate the possibility of congenital cholesteatoma.

Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients

BACKGROUND

To evaluate patients with middle ear cholesteatoma presenting with facial palsy (FP).

MATERIAL-METHODS

A total of 14 subjects (10 males and 4 females), with a mean age of 42.5 years, were included in our study. The majority of patients presented with incomplete FP (House-Brackmann HB II-IV, 11 cases) and the remaining 3 patients had complete facial paralysis (HB V-VI). A canal wall down mastoidectomy was performed in all the patients, followed by partial facial nerve decompression.

RESULTS

At the one-year follow-up, eleven (78.5%) patients demonstrated satisfactory recovery to HB I-II. Facial function recovered to HB grade I-II in 9 (100%) patients who were surgically treated within one month, and in 2 (40%) patients who underwent surgery after one month. The tympanic segment of facial nerve was the most common site of involvement (8 patients). The multiple regression analysis showed that a higher preoperative HB grade combined with a gradual than sudden onset of FP more likely resulted in worse postoperative HB grade.

CONCLUSION

Early surgical removal of cholesteatoma associated with FP is more likely to result in good facial nerve recovery (78.5% of cases), when it is performed within one month from the onset of FP. According to the literature, the tympanic segment of the facial nerve was more frequently damaged (77.7%), followed by the mastoid segment (22.9%), labyrinthine segment (11.1%), and geniculate ganglion (11.1%). Labyrinthine fistula, mainly of the lateral semicircular canal, can be expected in cases of facial nerve dehiscence. The canal wall down mastoidectomy combined with partial decompression surgery was the most preferred surgical treatment for the FP secondary to cholesteatoma.