Petrosal Cholesteatoma Presenting with Facial Twitching

Abstract

Cholesteatomas may have unusual presentations with devastating sequelae if not recognized early. These benign cyst-like lesions can occur from a congenital entrapment of squamous epithelium within temporal bone or be acquired secondary to tympanic membrane retraction or trauma. Cholesteatomas are traditionally found in the middle ear and mastoid region and exert their destructive properties due to mass effect, but are also known to have unusual presentations. We offer the case of a 32-year-old woman presenting with recurrent facial nerve palsy due to an intracranial cholesteatoma within the right temporal bone of the middle cranial fossa with dural invasion. This patient had recurrent cholesteatoma since childhood, emphasizing the point that long-term surveillance is crucial in this patient population due to the high risk of recurrence. We compare our case with other rare presentations of this process in the literature and also provide recent discoveries concerning the etiology and mechanism of cholesteatoma development along with the different surgical strategies that are implemented. Cholesteatoma continues to be an unusual diagnosis and we must remain vigilant of presentations outside the middle ear and continue to monitor patients with a history of this disease to prevent serious consequences to our patients.