Frontal sinus cholesteatoma: a masquerading diagnosis

Area of Science:

• Otolaryngology
• Neurosurgery
• Head and Neck Surgery

Background:

• Cholesteatoma, a benign epithelial cyst, is uncommon in the paranasal sinuses, unlike its frequent occurrence in the tympanomastoid region.
• Paranasal sinus cholesteatomas can cause significant bony erosion, leading to diagnostic challenges due to their resemblance to granulomatous or malignant tumors.

Observation:

• This case report details a patient with frontal sinus cholesteatoma presenting with forehead swelling.
• The condition's non-specific clinical and radiological findings complicated preoperative diagnosis, necessitating intraoperative confirmation.
• The patient required multiple surgical interventions due to the extensive nature of the cholesteatoma.

Findings:

• Cholesteatoma of the paranasal sinus presents a diagnostic challenge due to non-specific radiological and clinical signs.
• Extensive bony erosion by the cholesteatoma can mimic chronic granulomatous or malignant lesions.
• Histopathological examination remains the definitive diagnostic method for paranasal sinus cholesteatoma.

Implications:

• Frontal sinus cholesteatomas often necessitate a combined endoscopic and external surgical approach for complete eradication.
• Accurate diagnosis and complete surgical clearance are vital to prevent complications such as facial deformities, visual, and neurological deficits.
• Long-term, periodic follow-up is essential to monitor for and manage potential recurrences of the cholesteatoma.