Learning Objectives:

Objective: To analyze the clinical manifestations, classification, surgical approachs of Petrous Bone cholesteatoma(PBC) and restoration of facial nerve function.

Methods: From 2000 to 2014, 91 cases of petrous bone cholesteatoma underwent operations in the Chinese PLA general hospital. Clinical, audiological, and radiological findings, surgical approach with respect to the classification and facial nerve function were analyzed retrospectively.

Results: The most common symptoms were hearing loss and FN paralysis. All patients had petrous bone erosion with high resolution temporal bone CT scan. Out of the 91 PBC cases, 45 (45/91、49.45%) were supralabyrinthine, 7(7/91、7.69%) were infralabyrinthine, 12(12/91、13.19%) were infralabyrinthine-apical, and 27(27/91、29.67%) were massive with respect to Sanna's classification. All patients were radically removed the lesion. And 5 patients underwent transmastoid approach, 41patients underwent middle fossa approach, 34 patients were performed by translabyrinthine approach, 10 patients were performed by combined transmastoid and middle fossa approach, one patient was perfomed by combined translabyrinthine and sphenoid sinus approach. The most common affected section of facial nerve is labyrinth segment. Facial nerve decompression, primary end-to-end anastomosis, great auricular nerve graft and nerve substitution of facial-hypoglossal anastomosis were applied to restore the facial nerve function.

Conclusions: The most common symptoms of Petrous bone cholesteatoma were hearing loss and FN paralysis. The high resolution temporal bone CT scan has important value in finding PBC. The classification of PBC is fundamental to choose the appropriate surgical approach, and middle fossa approach is most common approach. Radical removal lesions should be prioritized over hearing preservation. Restoration of facial nerve (FN) function is achievable by reanimation procedures.