Rare Cause of Facial Nerve Palsy (Petrous Apex Cholesteatoma)–Case Report and Review of Literature

Rauf Ahmed

doi:10.11648/j.cnn.20190301.11

Abstract

The petrous apex is a pyramid-shaped structure that is formed by the medial portions of the temporal bone. It is obliquely positioned within the skull base, with its apex pointing anteromedially and its base located posterolaterally. The petrous apex is bounded by the inner ear structures laterally, the petro-occipital fissure medially, the petrosphenoidal fissure and ICA anteriorly, and the posterior cranial fossa behind. Given its location, the petrous apex is susceptible to multiple pathologic processes which may be Inflammatory, developmental, vascular, benign and malignant lesions. We present a rare case of a 39 year old Male who presented wit unilateral facial nerve palsy and sensoneural hearing loss and was then diagnosed as petrous apex Cholesteatoma. Patient was treated surgically by Transchoclear trasnlabrynth technique.

Highlights

The petrous apex is a pyramid-shaped structure that is formed by the medial portions of the temporal bone
There may be subtle peripheral rim enhancement. [2, 3] Diffusion-weighted imaging is useful in diagnosis of Cholestetoma, as the lesions often show restricted diffusion, a feature that can be beneficial in detection of recurrent Cholestetoma after surgical resection
Pandya etal [4] described some points that must be taken into considerations when treating patient with petrous apex Cholestetoma

Summary

Introduction

The petrous apex is a pyramid-shaped structure that is formed by the medial portions of the temporal bone. The petrous apex is susceptible to a variety of pathologic processes. Clinical presentations of these lesions, can be quite variable and depend largely on involvement of numerous intimately adjacent intra- and extra cranial structures, especially the cranial nerves. The patient had grade IV facial nerve palsy (Figure 1). Examination of other cranial nerves was normal. Patient had Grade 1 retraction on left side and the right ear was normal. (Figure 2) Pure tone audiogram done showed profound Sensoneural hearing loss in Left ear.

Case Report

Investigations

Treatment

Discussion

Conclusion