Extensive intratemporal cholesteatoma: Surgical strategy

Objective: To evaluate the decisional elements in the surgical strategy for extensive intratemporal cholesteatomas. Study Design: A retrospective review of cases followed up between 1985 and 1996. Setting: Tertiary referral center. Patients: Nineteen patients with temporal bone cholesteatoma extending beyo nd the middle ear limits and surgically treated were included. Preoperative imaging distinguished apical (8), infralabyrinthine (3), supralabyrinthine (3), retrolabyrinthine (1), and translabyrinthine (4) cholesteatomas. Intervention: Apical and supralabyrinthine lesions were treated through a m iddle fossa approach. Infralabyrinthine and translabyrinthine locations wer e exposed through a subtotal petrosectomy or a transotic route, depending o n the preoperative audiovestibular status and labyrinthine destruction on c omputed tomography. The retrolabyrinthine lesion was approached through a r etrolabyrinthine route. Main Outcome Measures: Patients were assessed for postoperative audiologic and Facial functions and for recurrence of tumor. Results: The facial nerve was neither rerouted nor interrupted during surge ry. Among the 12 patients with preoperative facial palsy (FP), 5 cases of i mprovement (42%), 6 cases of stable function (50%), and 1 case of mild dete rioration (8%) were observed postoperatively. In patients without preoperat ive FP, facial function remained unchanged postoperatively. The labyrinth c ould be preserved in three patients (16%), with postoperative stable hearin g function in two (11%), and a 40-dB mean auditory deterioration in one (5% ). Complete macroscopic resection was obtained in all patients. Two cases ( 11%) of postoperative recurrence were observed. Conclusion: The surgical strategy, principally based on cholesteatoma locat ion and preoperative auditory function, yielded a high rate of local diseas e control and facial function preservation.