title: Surgical management options and postoperative functional outcomes of petrous apex cholesteatoma.
abstract: CONCLUSIONS
  In cases of petrous apex (PA) cholesteatoma, radical removal should be prioritized over an unreasonable sparing of hearing or facial symmetry. Nevertheless, for patients with serviceable hearing and spared inner ear structures, conservative approaches may be applicable. Restoration of facial nerve (FN) function is achievable by reanimation procedures.
  
  
  OBJECTIVE
  To analyze clinical manifestations, surgical techniques, and postoperative functional results of PA cholesteatoma.
  
  
  METHODS
  From 1987 to 2010, 13 cases of PA cholesteatoma underwent operations. Clinical, audiological, and radiological findings, surgical approach, and postoperative functional outcomes were analyzed retrospectively.
  
  
  RESULTS
  The most common symptoms were hearing loss and FN paralysis. All PA cholesteatomas extended to the middle ear; 10 (76.9%) through the anterior-superior route, whereas the other 3 (23.1%) were through the posterior-superior route. In 10 patients, labyrinthectomy was inevitable because of inner ear invasion. However, three limited cholesteatomas were removable via the middle cranial fossa or transmastoid approach without changing the bone-conduction threshold. Among six cases with FN paralysis, one underwent interposition graft, two FN decompression, and the others hypoglossal-FN anastomosis. One FN decompression case recovered to House-Brackmann grade I, and all other reanimation cases finally presented with grade IV. There were no major complications or recurrences during the follow-up period.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jae-Jin
authors.initials: JJ
authors.lastname: Song
authors.forename: Yong-Hwi
authors.initials: YH
authors.lastname: An
authors.forename: Soon-Hyun
authors.initials: SH
authors.lastname: Ahn
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Yoo
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Seung Ha
authors.initials: SH
authors.lastname: Oh
authors.forename: Chong Sun
authors.initials: CS
authors.lastname: Kim
authors.forename: Sun O
authors.initials: SO
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D001847:Bone Diseases / Q000150:complications / Q000601:surgery*; D002781:Cholesteatoma / Q000150:complications / Q000601:surgery*; D005155:Facial Nerve Diseases / Q000209:etiology / Q000601:surgery; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery; D005260:Female; D034381:Hearing Loss / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D010579:Petrous Bone / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D055502:Secondary Prevention; D055815:Young Adult