Abstract
The aim of this study was to present a rare case report of myxoma of the mastoid cleft/temporal bone with intracranial extension and its management and follow-up. A 13-year-old girl presented with discharge from the right ear with gradually progressive hearing loss for the last 4–5 years and facial palsy of grade III on the right side for the last 4–5 months. She was diagnosed as having chronic otitis media, squamosal type, and underwent canal wall down mastoidectomy on the same ear 6 months back. On examination, an aural polyp occupying the whole of the mastoid cavity along with mucopurulent discharge and lower motor neuron facial palsy were seen on the right side. high resolution ct scan (HRCT) of the temporal bone showed a soft tissue mass occupying the whole of the mastoid cavity breaching bony confinements, extending up to the posterior fossa, extradurally, and engulfing the facial nerve. The patient underwent reexploration of the right mastoid cavity under general anaesthesia and a soft jelly-like substance was removed from whole of the mastoid cavity, extending anteriorly up to the Eustachian tube, inferiorly up to the jugular bulb, posteriorly up to the retrosigmoid cells, superiorly up to the tegmen plate, extending medially intracranially up to the posterior fossa dura through Trautmann’s triangle and engulfing the facial nerve from the first genu to the stylomastoid foramen. Facial nerve decompression was performed along with disease clearance and wide conchomeatoplasty. The patient developed grade IV facial palsy postoperatively. The histopathology report of the dissected jelly-like soft tissue revealed myxoma. The patient is at present under regular follow-up and there is no recurrence after 6 months, although facial palsy is still persisting as grade IV. Myxoma of the temporal bone or the mastoid cleft is a rare entity. Complete surgical excision is the treatment of choice in this case, although recurrence is very common. The clinical presentation, management and outcome of this tumour are discussed in view of available literature.
Highlights
Myxoma, the name coined by Virchow, in 1871, is a rare tumour, which according to him had a similar appearance to the mucinous tissue of the umbilical cord [1]
We present and discuss the case of a young girl who was diagnosed as having myxoma of the temporal bone with intracranial extension and its management
The patient is at present under regular follow-up and there is no recurrence after 6 months, facial palsy is still persisting as grade IV (Figs 1–5)
Summary
The name coined by Virchow, in 1871, is a rare tumour, which according to him had a similar appearance to the mucinous tissue of the umbilical cord [1]. Primary myxomas of the temporal bone are very rare tumours These benign tumours can grow into locally aggressive expansile masses, resulting in hearing loss, facial paralysis, dural invasion and mass effect on the adjacent brain parenchyma [2]. Case report S.N., a 13-year-old girl, presented to the ENT OPD of a tertiary care hospital of Kolkata with complaints of discharge and hearing loss in the right ear for the last 4–5 years and deviation of the angle of mouth to the left side for the last 4–5 months She was diagnosed as having squamosal type of chronic otitis media and underwent canal wall down mastoidectomy on the right side 6 months back. The patient is at present under regular follow-up and there is no recurrence after 6 months, facial palsy is still persisting as grade IV (Figs 1–5)
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