Author(s)
Rijul Kshirsagar, MD
Brian Song, MD
Jonathan Liang, MD
Affiliation(s)
Kaiser Permanente Oakland Medical Center
Abstract:
Objectives: Frontal sinus cholesteatoma is a rare condition, with 17 reported cases, that has historically been treated with open approaches. The aims of this study are: (1) to describe the presentation, imaging, and endoscopic treatment of frontal sinus cholesteatoma; and (2) to review the literature focusing on the historic and contemporary treatments of frontal sinus cholesteatoma. Methods: A case study. A 45-year-old man presented with a 1-week history of right eyelid and forehead swelling, and was found to have a frontal sinus cholesteatoma. He underwent endoscopic sinus surgery in January 2017 at a tertiary care center. Results: Examination revealed a 2×2-cm area of swelling of the right forehead with an underlying 1×1-cm frontal bony defect. No significant findings were seen upon nasal endoscopy. Computed tomography and magnetic resonance imaging revealed a right frontal sinus expansile lesion of soft tissue density with marked bony remodeling and multifocal bone dehiscence along the superior orbit and posterior table. No intracranial or intraorbital extension was observed. The patient underwent right-sided endoscopic maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with subtotal debridement of keratin debris and cholesteatoma matrix within the right frontal sinus. The pathological analysis demonstrated abundant keratin debris, consistent with cholesteatoma. Postoperatively, the patient’s symptoms resolved and are continually managed with serial clinic endoscopic debridements and nasal saline rinses. Conclusions: Frontal sinus cholesteatoma is a rare entity historically managed by total extirpation through open approaches, which can entail significant morbidity. With sophisticated endoscopic sinus instrumentation and image guidance, we describe a case of frontal sinus cholesteatoma successfully managed via an endoscopic approach.