The patient, Mr. Sun, who suffered from facial paralysis for more than 30 years, was relieved by acupuncture at first, and later had repeated episodes of facial paralysis, not only acupuncture treatment was no longer ideal, but also developed balance disorders, vertigo and total deafness. Finally, through CT examination of the temporal bone and MRI examination of the enhanced skull base, the results showed that the "real culprit" that caused his facial paralysis was petrous bone cholesteatoma.
Petrogyocholesteatoma is an epidermoid cyst involving the petrous temporal bone that accounts for 2.9% of all cholesteatomas. Although it is a benign lesion, petrous bone cholesteatoma has a strong erosion and damage ability. Because it is embedded deep in the ear like a screw, and there is also the inner ear and three nerves - the facial nerve that innervates the movement of the facial muscles, the auditory nerve responsible for hearing and the vestibular nerve of somatic balance, when cholesteatoma destroys the inner ear and these three nerves, symptoms such as facial paralysis, deafness, vertigo and balance disorders will strike together.
Returning to the case of Mr. Sun, due to its long illness, cholesteatoma not only destroyed the three major nerves, invaded the middle and posterior cranial fossa, but also destroyed the bone around the arteries and veins in the skull base, and the cholesteatoma was closely attached to the meninges and internal neck arteries and veins, and if not treated in time, serious complications such as intracranial infection and vascular rupture may occur.
Eventually, Mr. Sun decided to be admitted to the hospital for surgery. With the cooperation of multi-department doctors, the lesion area can be accurately located through 3D navigation instruments. While protecting the important tissues of the brain and internal carotid artery, the cholesteatoma was successfully removed, and the cholesteatoma cyst wall was carefully scraped to reduce the residual lesion and reduce the chance of disease recurrence. A few days ago, Mr. Sun has recovered and been discharged from the hospital.
Experts here remind that the onset of rock bone cholesteatoma is insidious and often widely damaged when found, and it is necessary to be alert to the disease for unilateral and gradually severe deafness and vertigo, especially with facial paralysis symptoms, and should go to the hospital in time.
Text/Chen Junyan (Beijing Tsinghua Chang Gung Hospital)