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. 2008 Mar;18(2):107-15.
doi: 10.1055/s-2007-991112.

Petrous temporal bone cholesteatoma: a new classification and long-term surgical outcomes

David Moffat  1 , Stephen Jones, Wendy Smith
Affiliations

Petrous temporal bone cholesteatoma: a new classification and long-term surgical outcomes

David Moffat et al. Skull Base. 2008 Mar.

Abstract

The goals of this retrospective case review were to analyze the long-term results of surgery for petrous temporal bone cholesteatomas and to propose a new classification system for these lesions. Patients with a surgically confirmed petrous temporal bone cholesteatoma were treated at Addenbrooke's Hospital, a tertiary referral center. Postoperative facial function, hearing, residual/recurrent cholesteatoma, and other complications were assessed in relation to preoperative signs, intraoperative findings, and surgical approach. Between 1983 and 2004, 43 patients were treated. There were no perioperative deaths. There was no long-term recurrence in 95.4% of the patients, possibly because of meticulous surgical technique, bipolar diathermy, and use of the laser to denature the cholesteatoma matrix that was adherent to the dura. At presentation, 95% of the patients had no socially useful hearing in the affected ear. Facial nerve function, however, was usually preserved. Both direct anastomosis and nerve grafting can improve facial nerve function from House-Brackmann grade VI to grade III if the palsy is not longstanding. Four patients had cerebrospinal fluid leakage; other complications were rare. The proposed classification facilitates surgical planning and predicts the postoperative outcome with regards to hearing.

Keywords: Petrosal cholesteatoma classification; hearing.

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Figures

Figure 1
Figure 1
Moffat-Smith classification. Supralabyrinthine, above the labyrinth; supralabyrinthine-apical, above the labyrinth extending to the petrous apex; infralabyrinthine, below the labyrinth; infralabyrinthine-apical, below labyrinth extending to petrous apex; massive labyrinthine, extensive destruction of inner ear; massive labyrinthine-apical, extensive destruction of inner ear extending to petrous apex; apical, confined to petrous apex.
Figure 2
Figure 2
Comparison of the pre- and postoperative facial nerve function according to House-Brackmann grades.
Figure 3
Figure 3
Comparison of the pre- and postoperative hearing levels as measured by mean air conduction thresholds.
See this image and copyright information in PMC

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