Primary cholesteatoma of petrous bone presenting as cervical fistula

A unique case of primary cholesteatoma of the petrous bone is described. The patient presented with it cutaneous fistula of the anterior cervical triangle and was initially diagnosed and treated as sebaceous cyst or imflammatory lympha node for 3 months. Later examination showed white mass in the right external auditory canal and a severe conductive hearing loss. Radiological findings revealed a massive soft tissue consistent with cholesteatoma in the right petrous bone. The lesion was successfully managed with an endoscopy-assisted technique leaving the neurovascular structures in situ without operative complications. A review of the literature shows that only a few cases of cervical abscess associated with mastoid cholesteatoma have been reported. We also discussed the diagnosis, clinical features and surgical strategy for petrous bone cholesteatoma. (C) 2008 Elsevier Ireland Ltd. All rights reserved.