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Updated: Dec 13, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Facial nerve dehiscence and cholesteatoma: Pediatrics vs adults
Giampiero Gulotta1, Irene Claudia Visconti1, Annalisa Pace1
1Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy.
Insights
Facial canal dehiscence (FCD) is more common in adults than children, particularly in those with chronic otitis media and cholesteatoma. Longer disease duration increases FCD risk in adults, with the tympanic segment most frequently affected.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Surgery
Background:
- Chronic otitis media with acquired cholesteatoma can lead to complications affecting the facial nerve.
- Facial canal dehiscence (FCD), an abnormal opening in the bony covering of the facial nerve, is a significant concern in middle ear surgery.
- Understanding the incidence and risk factors for FCD in different age groups is crucial for surgical planning and patient outcomes.
Purpose of the Study:
- To investigate the incidence of facial canal dehiscence (FCD) in pediatric versus non-pediatric patients with chronic otitis media and acquired cholesteatoma.
- To analyze differences in FCD frequency based on age, surgical history (primary vs. revision), and disease duration.
- To identify the most common localization of FCD within the facial canal in both age groups.
Main Methods:
- A retrospective study of 527 patients with chronic otitis media and acquired cholesteatoma.
- Patients were divided into two groups: pediatric (under 18 years, n=57) and adult (18 years and over, n=470).
- Data collected included FCD incidence, localization, surgical history, and disease duration.
Main Results:
- Overall FCD incidence was 25.7% in adults and 7% in pediatric patients.
- Revision surgeries showed higher FCD rates (43.5% in adults, 16.7% in children).
- Diseases longer than 5 years correlated with higher FCD incidence in adults (29.9%) compared to pediatric patients (7.3%). The tympanic tract was the most common site of dehiscence in both groups.
Conclusions:
- Facial canal dehiscence (FCD) is significantly more prevalent in adult patients compared to pediatric patients.
- Adults undergoing primary surgery exhibit a higher incidence of FCD than children.
- While disease duration under 5 years showed no significant difference, longer durations (>5 years) increase FCD risk in adults, with the middle tract of the tympanic segment being the most affected site in both populations.
Objectives:
the aim of this paper is to study the incidence of facial canal dehiscence (FCD) in pediatric and non-pediatric patients, analyzing eventual differences in frequency, localization, primary or revision surgery and duration of the disease.
Methods:
527 patients suffering from chronic otitis media with acquired cholesteatoma, divided into two groups, those aged 18 years or over (470 patients), and those aged below 18 years (57 patients).
Results:
Total incidence of FCD in adult population was 25,7% (121/470) and 7% (4/57) in pediatric one. Globally higher values were found in revision surgery, 43,5% (40/92) in adults and 16,7% (1/7) in children. Diseases longer than 5 years have been correlated to higher incidence of FCD in adults, 29,9% (109/364), than in pediatrics, 7,3% (3/41). No statistical significant difference has been found in those with a disease shorter than 5 years: 11,3% in adults (12/106) and 6,2% in children (1/16). The majority of patients, both adults and pediatrics, had a dehiscence in the tympanic tract of facial nerve. No statistical correlation regarding concomitant semicircular canal fistula and FCD has been found due to the absence of data in children.
Conclusions:
Incidence of FCD is higher in adult population than in pediatric. Adults have a higher incidence in primary surgery than children. No statistical significant difference has been found in adults and pediatrics with a less than 5 years disease, while diseases longer than 5 years expose adults to higher risk of FCD. Middle tract of tympanic segment is the most involved site of dehiscence in both populations.
