Cholesteatoma of the Frontal and Ethmoid Areas

Abstract

Cholesteatomas of the frontoethmoid region must always be considered in the differential diagnosis of a mass in the frontoethmoid region. A painless, slow-growing mass, often accompanied by proptosis and diplopia, but without history of trauma or infection, should make one suspect of this pathologic entity. Although histologically a benign lesion, the keratinizing squamous epithelial lining will continue to desquamate and expand, leading to erosion of surrounding structures which could be life-threatening. In order to prevent recurrence, complete removal of the cyst lining is mandatory. Cosmetic reconstruction, often requiring obliteration of the surgical cavity, should be delayed for one year to insure against recurrence of the covering of active squamous tissue adjacent to dura, cribriform plate or ocular structures.

Giant Intradiploic Epidermoid Cyst of Greater Sphenoid Wing Causing Unilateral Proptosis and Optic Nerve Compression

“…[4][5][6]8,10,11 Without complete removal of the cyst wall, recurrence is likely.' In the case presented here, removal of the cyst wall by curettage and drilling was performed because the patient rejected the option of complete removal of the affected sphenoid bone preoperatively and the diagnosis of an intradiploic epidermoid was not made until after the histologic sections had been examined.…”

“…5 Epidermoids involving the frontal ethmoidal and orbital regions may cause proptosis and visual disturbance. 6,7 Intradiploic epidermoid cysts have been found in all the bones of the calvarium, temporal and sphenoid bones, paranasal sinuses, and maxilla. They occur most often in the frontal and parietal areas and at the junctions of the calvarium with the skull base.2 The parietal, occipital, and frontal bones each account for 12 to 15% of cases.…”

Intradiploic Epidermoid Cyst of the Sphenoid Wing

“…Degenerating epithelium within the cyst initiates a foreign-body reaction characterized by giant cells, cholesterol crystal for¬ mation, hemosiderin, and fibrosis. 13 Expansive pressure and enzymatic digestive activity of the tumor result in bony erosion. Vascular channels are distinctively absent.…”

“…Rarely are these tumors produc¬ tive of significant neurologic symptoms, but occasional focal seizures, as in the case report, have been noted.7·25 Approximately 30 case reports of cholesteatomas involving the frontal, ethmoidal, and orbital regions have appeared in the literature. 13 Symp¬ toms associated with epidermoids in these areas include headache, propto¬ sis, visual disturbances, and one report of extradural hematoma.26 In the case of orbital lesions, the superi¬ or temporal aspect of the orbit is primarily involved, often communi¬ cating with the frontal and ethmoidal sinuses.14 Other slow-growing lesions in the frontal and ethmoidal regions that must be considered in the differ¬ ential diagnosis include mucoceles, chronic osteomyelitis, osteomas, fi¬ bromas, lipomas, dermoide, and seba¬ ceous cysts.913·25 Systemic conditions presenting as a frontal mass or exoph¬ thalmos are thyrotoxicosis, pseudotumor of the orbit, leukemic infiltration, lymphosarcoma, and diffuse neurofibromatosis.13·25…”

Cholestéatome du sinus frontal

“…Une revue de la littérature anglo-saxonne retrouve moins d'une trentaine de cas [1][2][3]. Des déformations faciales, un ptosis, une altération de la vision ont été décrits comme symptômes révélateurs de cette pathologie [4,5]. Des cas de dégénérescence maligne et des décès ont même été rapportés [3,6].…”