Learning Objectives:

Introduction: Parapharyngeal abscess as a cervical complication of the cholesteatoma is an extremely rare disease. In the modern antibiotic era only a few cases of this life-threatening complication have been reported in the literature. The different routes of extension, e.g. peritubal, through the eroded mastoid tip or due to the involvement of the apex of the petrous temporal bone, have been previously described. However, the appropriate time and surgical strategies for management of the complication and principal disease are still controversial.

Methods: This is a retrospective descriptive case report based on clinical chart data and analysis of computed tomography scans.

Results: A 65-year-old man with a long history of recurrent right purulent otorrhea presented to our tertiary care facility with right temporal bone fracture. Later, he started to complain of hoarseness, snoring and dysphagia and was diagnosed with right parapharyngeal abscess on a contrast enhanced computed tomography scan. The patient underwent abscess drainage through transcervical route with simultaneous emergency radical mastoidectomy. Despite development of septic shock with acute renal failure in the postoperative period the patient recovered.

Conclusions: Temporal bone fracture in patients with pre-existing chronic otitis media with cholesteatoma can cause infection extension to the deep neck spaces through the fracture bone defects. Early consultation of an otologist is indicated in such cases. Analysis of the computed tomography scans with thorough evaluation of the fracture line extension should be performed to prevent the complications.

Learning Objectives: Due to the rarity the cervical complications of the cholesteatoma are requiring a high index of suspicion among otologists. To increase awareness of this condition, we report this unique case.