External Auditory Canal Cholesteatoma Involving the Vertical Segment of the Facial Nerve: A Rare Case Report

Abstract

External auditory canal cholesteatomas (EACC), are rare, more so when they affect the facial nerve in its vertical mastoid segment. EACC are known to possess bone eroding properties, causing a variety of complications, similar to the better-known attic cholesteatomas. We describe here the novel surgical management of a case of EACC, affecting only the vertical segment of the facial nerve, causing seventh nerve palsy at the time of presentation. A 46 year old male, complaining of right-sided otalgia and otorrhea, presented with grade IV facial palsy and associated mild conductive hearing loss. Clinical examination and radiological investigations suggested the diagnosis of an external auditory canal cholesteatoma. The patient underwent a trans-canal facial nerve decompression along with the cholesteatoma removal. Post-operatively, the patient showed marked clinical improvement with the facial palsy reverting to grade II. EACC involving only the vertical segment of the facial nerve can be approached via the trans-canal route, in contrast to the conventional postauricular approach, with a good clinical outcome. To the best of our knowledge, our case pertains to the only case of EACC with complications, managed by trans-canal facial nerve decompression.

Keywords: External auditory canal cholesteatoma; Facial nerve; Facial nerve decompression; Facial nerve palsy; Keratosis obturans.

Fig. 1

HRCT image (top panel) and intra-operative photograph (bottom panel). High-Resolution Computed Tomography picture (top panel) showing widened EAC on the right side. The white arrow shows the exposed vertical segment of the facial nerve. Intraoperative view (bottom panel) showing the exposed facial nerve. The sheath of the vertical segment of the facial nerve (arrow) was incised to decompress the nerve via the trans-canal route. (Patient consent obtained for the publication of the photograph)

Fig. 2

Preoperative (left) and postoperative (right) clinical photograph of the patient. The facial palsy improved throughout the follow-up. (Patient consent obtained for publication of the photograph)