Abstract
A 68-year-old male was found to have a congenital giant cholesteatoma arising from the mastoid extending into the occipital area; he was seen by a dermatologist for ear pain, and was diagnosed as having an inflammatory atheroma. Excision of the atheroma was performed under local anesthesia. However, the lesion had extended into the deeper layers of the skin, and after excising as much as possible, we closed the wound. However, after few months, the patient developed heaviness of the head and otorrhea from the right ear. Computed tomography revealed a giant cholesteatoma extending into the occipital area. Then, the patient was referred to our clinic. Computed tomography of the brain revealed an expanding soft tissue shadow centered on the mastoid of the right ear, and destruction in the posterior cranial fossa. Because of the extension into the occipital area and suspected adhesion to the posterior fossa dura mater, operation was performed by an otolaryngologist, brain surgeon, and plastic surgeon. We exfoliated the membrane of the cholesteatoma from the ear canal, and removed the cholesteatoma. Despite the adhesion to the posterior fossa dura mater, we could successfully exfoliate the membrane of the cholesteatoma, and there was no invasion of the central nervous system. A year after the operation, magnetic resonance imaging of the brain revealed no recurrence of the cholesteatoma. In patients with atheroma in the occipital area or those showing an expanding soft tissue shadow arising from the mastoid process of the ear, the possibility of a giant cholesteatoma must be borne in mind.
