CHOLESTEATOMA

Congenital Patterns

© Bruce Black MD

Right Congenital cholesteatoma. Classic spherical “pearl” anterior to the handle of the malleus.

© Bruce Black MD

Congenital cholesteatoma extending from the antero-superior middle ear, under the handle of the malleus. Small

extension seen just posterior to the handle. © Bruce Black MD

Unusual “dumbbell” pattern congenital cholesteatoma in the anterior mesotympanum.

© Bruce Black MD

Rt, congenital cholesteatoma, suggestion of posterior extension into the posterosuperior mesotympanum,

abutting the stapes. © Bruce Black MD

Lesion in the anterior mesotympanum suggestive of a congenital cholesteatoma. Exploration revealed a mass of free keratin, evidently from a now involuted cholesteatoma. © Bruce Black MD

A large anterior mesotympanic congenital cholesteatoma. Slight lateral displacement of the malleus handle causing

drum irregularity around the umbo. © Bruce Black MD

An unusual congenital rest over the pars flaccida. Resolving acute otitis media, fluid level at 3.00 o’clock. The lesion was

marsupialised under topical anaesthesia. © Bruce Black MD

An unusual pars flaccida congenital cholsteatoma, extending superficial to the incus and stapes. Diffuse attic

involvement. © Bruce Black MD

Surgical approach to an antero-superior congenital cyst. A superior tympano-meatal flap is used. Handle detachment

and attic curettage may be required for removal. © Bruce Black MD

Clearance of an anterior sac using handle displacement. Periosteum is peeled from the handle undersurface to facilitate a plane of removal, to avoid residual disease. © Bruce Black MD

Right congenital cholesteatoma, transcanal superior tympanotomy surgical view. The malleus handle has been displaced laterally to access an anterosuperior middle ear

cyst. © Bruce Black MD

Congenital cholesteatoma filling the posterior mesotympanum, probably extending antero-superiorly

beneath the malleus handle, and into the attic. © Bruce Black MD

A very large congenital cholesteatoma filling the entire mesotympanum, extending into the attic and mastoid. A previous myringotomy has opened the cyst anteriorly. © Bruce Black MD

Pearly white pars tensa appearance due to extensive middle ear congenital cholesteatoma. A previous myringotomy reveals keratin deep to the drum. © Bruce Black MD

Right congenital cholesteatoma, surgical view via the mastoid during intact canal wall surgery . A pearly cystic

lesion fills the attic. © Bruce Black MD

Congenital hamartoma, right mastoid. Unlike cystic congenital cholesteatoma, the lesion is coated exteriorly

with hair-bearing skin. © Bruce Black MD

Coronal CT of the right middle ear. A cholesteatoma is seen in the upper mesotympanum, extending into the lower attic.

© Bruce Black MD

Coronal CT showing a Rt. petrous apex cholesteatoma. Asymptomatic.

© Bruce Black MD

Lt. petrous apex cholesteatoma presenting with retro-orbital ache and VI paresis.

© Bruce Black MD

Squamous epithelium coating the under-surface of an intact pars tensa. Middle ear infection-free. Possible old ruptured

congenital cholesteatoma. © Bruce Black MD