Management of giant cholesteatoma

Complete excision of cholesteatoma of the petrous apex is often limited by persistent disease and by involvement of vascular, neural, or intracranial structures. This article presents four patients with giant cholesteatomas, who were successfully treated by permanent exteriorization. The surgical approach used was individualized based on the extent of the disease. Silastic sheeting was used to maintain the path of exteriorization and to provide drainage. An essential part of each patient's care was vigilant postoperative cleaning of the surgical defect. Although incomplete surgical excision is not a usual goal in cholesteatoma surgery, exteriorization can provide a safe and effective treatment in select cases.