Potential recurrence is a key challenge of the surgical interventions for temporal bone cholesteatoma. It manifests with the residual or recurrent cholesteatoma. Open surgical techniques reduce the recurrence of cholesteatoma due to the better visualization of temporal bone cavities both intraoperatively and postoperatively and also prevent otogenic intracranial complications. However, even despite open-cavity surgeries, cholesteatoma recurrences are still common in ENT practice while their asymptomatic course often results in the late diagnosis. This article describes three case reports of cholesteatoma recurrences with significant destructive lesions of the temporal bone and intracranial complications after prior open-cavity surgical interventions. These case reports are of interest due to the latent course of cholesteatoma and the lack of disease recurrence signs revealed by the standard ENT examination using otomicroscopy and endoscopy. Finally, these case reports highlight the importance of diffusion-weighed magnetic resonance imaging of the middle ear in patients with temporal bone cholesteatoma both in the preoperative and postoperative period. KEYWORDS: cholesteatoma, middle ear, temporal bone, surgical strategy, trephination, radical mastoidectomy. FOR CITATION: Anikin I.A., Khamgushkeeva N.N., Knyazev A.D., Bokuchava T.A. Massive cholesteatoma of the temporal bone after opencavity surgery. Russian Medical Inquiry. 2020;4(4):247–253. DOI: 10.32364/2587-6821-2020-4-4-247-253.