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case_images: Computed Tomography in axial and coronal view gave evidence of the extention of the mastoid cholesteatoma without involvement of middle ear and aditus ad antrum. Erosion of the mastoid process at the level of digastric ridge, and the exposed stylomastoid foramen (white arrow).
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case_images: Tomographic (CT) scan of the temporal bone revealed an expansive destructive lesion in the right mastoid process. The middle ear, attic, aditus, and antrum were disease free (Figure 1).
case_images: Magnetic resonance imaging. T2-weighted images showed hyperintense lesion with a size of 20 x 31 mm (arrow).
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case_images: On magnetic resonance imaging (MRI), the lesion appeared hypointense on T1- weighted images and hyperintense on T2-weighted images with a size of 20 x 31 mm (Figure 2).
case_images: Intraoperative view. Aditus ad Antrum (black arrow). Matrix of Cholesteatoma (white arrows).. Abbreviation: SS, sigmoid sinus.
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case_images: The bone covering the middle fossa dura, presigmoid, and retrosigmoid posterior dura as well as that of the sigmoid sinus (SS) was completely eroded (Figure 3).
case_images: Intraoperative view. Matrix of Cholesteatoma (arrows). (A) Soft tissue separating the temporal bone from the neck after matrix removal. The bone was completely eroded by cholesteatoma, (B) Stylomastoid Foramen. (C). Digastric ridge.
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case_images: It was in close contact with the soft tissue of the stylomastoid foramen as well as the posterior belly of the digastric muscle (Figure 4).