Primary cholesteatoma of petrous bone presenting as cervical fistula

A unique case of primary cholesteatoma of the petrous bone is described. The patient presented with a cutaneous fistula of the anterior cervical triangle and was initially diagnosed and treated as sebaceous cyst or imflammatory lympha node for 3 months. Later examination showed white mass in the right external auditory canal and a severe conductive hearing loss. Radiological findings revealed a massive soft tissue consistent with cholesteatoma in the right petrous bone. The lesion was successfully managed with an endoscopy-assisted technique leaving the neurovascular structures in situ without operative complications. A review of the literature shows that only a few cases of cervical abscess associated with mastoid cholesteatoma have been reported. We also discussed the diagnosis, clinical features and surgical strategy for petrous bone cholesteatoma.