Management of Cholesteatoma and Tegmen Dehiscence: Complexities and Nuance

Objectives: Cholesteatoma and bony tegmen dehiscence may coexist in the same patient, occasionally with cholesteatoma causing the dehiscence. Surgical management of coexistent disease is poorly explored in the literature. The purpose of this study is to identify characteristics of safe surgical intervention.

Study Design: Case series.

Setting: Tertiary care centers.

Materials and Methods: Patients were identified in chart review at two tertiary care centers between 2011 and 2019 as having coexistent cholesteatoma and tegmen dehiscence. Patient were included if surgery had been performed to address both pathologies.

Results: Thirty cases were identified in 28 patients. Average patient age was 49 years (range 10–81 year), and average follow up was 29 months (range: 2.5 to 84 months). Tegmen dehiscence repair was performed via transmastoid approach in 21 cases and via middle cranial fossa approach in nine patients. Decision making for the approach was based on the apparent size and location of the tegmen dehiscence, as well as the presence of encephalic herniation through the dehiscence. Postoperative skull base complications were identified two patients.

Conclusions: Management of tegmen dehiscence in the setting of cholesteatoma is a challenging problem. Careful preoperative planning may help prevent complications.

No conflict of interest has been declared by the author(s).