A Case of Facial Nerve Paralysis Caused by Pediatric Congenital Cholesteatoma

Abstract

We report a rare pediatric case of congenital cholesteatoma initially manifesting as facial paralysis. A 3-year-old boy seen for acute facial palsy had developed left facial paralysis on January 4, 2008, undergoing predonisolone therapy by a local pediatrician from January 10. Upon referred on March 5, facial palsy was a severe Grade V in House-Brackman classification. Middle-ear computed tomography showed soft tissue filling the mastoid antrum through the epitympanic recess to the tympanic cavity. Endoscopic examination identified swelling of the tympanic membrane and a yellowish-white tumor of the tympanic cavity. Based on a diagnosis of congenital cholesteatoma, he underwent surgery under general anesthesia on June 27. The cholesteatoma lesion occupied the tympanic cavity, extending to the aperture of the mastoid antrum. In staged surgery, the exposed facial nerve in the tympanic cavity appeared hyperemic and adjacent to the cholesteatoma lesion. Postoperatively, facial paralysis improved incompletely remaining in Grade III in House-Brackmann classification.