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Tympanic Membrane Erosion

Figure 10.5 The apical type of petrous bone cholesteatoma is a rare congenital lesion. It may solely involve the apical compartment, causing erosion of it. It may involve the trigeminal nerve or more posteriorly the posterior cranial fossa. It may also engulf the horizontal portion of the internal carotid artery.

Figure 10.5 The apical type of petrous bone cholesteatoma is a rare congenital lesion. It may solely involve the apical compartment, causing erosion of it. It may involve the trigeminal nerve or more posteriorly the posterior cranial fossa. It may also engulf the horizontal portion of the internal carotid artery.

Cholestoma Tempanic Membrane

Figure 10.6 Left acquired or iatrogenic supralabyrinthine petrous bone cholesteatoma in a radical cavity. A whitish retrotympanic mass is seen at the level of the second portion of the facial nerve. The patient presented with progressive facial nerve paralysis and total hearing loss. A correct diagnosis depends not only on otoscopy but also on the symptomatology (facial paralysis, anacusis) and a high-resolution CT scan.

Images Scan Cholesteatoma

Figure 10.7 CT scan of the case presented in Figure 10.6, axial section. Involvement of the lateral semicircular canal and the vestibule is well visualized. The cholesteatoma invades the cochlea anteriorly, while medially it reaches the fundus of the internal auditory canal. The posterior semicircular canal is not invaded.

Figure 10.6 Left acquired or iatrogenic supralabyrinthine petrous bone cholesteatoma in a radical cavity. A whitish retrotympanic mass is seen at the level of the second portion of the facial nerve. The patient presented with progressive facial nerve paralysis and total hearing loss. A correct diagnosis depends not only on otoscopy but also on the symptomatology (facial paralysis, anacusis) and a high-resolution CT scan.

Figure 10.7 CT scan of the case presented in Figure 10.6, axial section. Involvement of the lateral semicircular canal and the vestibule is well visualized. The cholesteatoma invades the cochlea anteriorly, while medially it reaches the fundus of the internal auditory canal. The posterior semicircular canal is not invaded.

Tympanic Membrane

Figure 10.9 Postoperative CT scan. A transcochlear approach was performed and the operative cavity was obliterated with abdominal fat.

Figure 10.8 CT scan of the case presented in Figure 10.6, coronal section. The medial extension of the cholesteatoma can be appreciated.

Figure 10.9 Postoperative CT scan. A transcochlear approach was performed and the operative cavity was obliterated with abdominal fat.

Images Scan Cholesteatoma

Figure 10.10 Right acquired supralabyrinthine petrous bone cholesteatoma. A whitish mass is present in the mastoid cavity of an open tympanoplasty. The mass occupies the whole epitympanum and extends interiorly behind the tympanic membrane. The patient presented with ipsilateral facial paralysis and conductive hearing loss.

Figure 10.10 Right acquired supralabyrinthine petrous bone cholesteatoma. A whitish mass is present in the mastoid cavity of an open tympanoplasty. The mass occupies the whole epitympanum and extends interiorly behind the tympanic membrane. The patient presented with ipsilateral facial paralysis and conductive hearing loss.

Figure 10.11 CT scan of the case presented in Figure 10.10. The cholesteatoma invades the cochlea. Total removal of the pathology was accomplished using a transcochlear approach with obliteration of the operative defect using abdominal fat. The external auditory canal was closed as cul-de-sac. The facial nerve was infiltrated at the level of the geniculate ganglion and was repaired using a sural nerve graft.

Perforated Tympanic Mebrane
Figure 10.12 Another example of right acquired supra-labyrinthine petrous bone cholesteatoma. The patient presented with right facial nerve paralysis. Otoscopy reveals a right epitympanic erosion.

Figure 10.13 CT scan of the case presented in Figure 10.12, coronal view. Typical location and erosion of acquired small supralabyrinthine petrous bone cholesteatoma.

Tympanic Membrane Pathology

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