Frontal Sinus Cholesteatoma

Abstract

Objective: To describe a case of frontal sinus cholesteatoma and review the characteristics of this pathology.

Method: Case report: 32-year-old white man. First symptoms: frontal pressure, proptosis of left eye with downward displacement (no visual symptoms or eye movement impairment). ENT examination and nasal endoscopy were normal. CT of paranasal sinuses: large mass in the left frontal sinus, with destruction of orbital and cranial blades.

Results: An endoscopic approach of the frontal sinus was attempted with no success. Nothing could be extracted from the left frontal sinus. Therefore an open approach was attempted, an external approach, using a Lynch incision. By this method we were able to clear out the medial and lateral parts of the left frontal sinus, taking out enough material to be examined by the pathologist. What came out was a cheese-like debris with a pearly aspect. The final histopathological analysis revealed that the mass was a cholesteatoma of the frontal sinus.

Conclusion: Cholesteatoma is a common pathology of the middle ear. There are few cases reported in the paranasal sinuses. The cholesteatoma is a benign tumor that can become locally aggressive when it promotes erosion of the bone by pressure and also by the production of proteolytic substances, invading the surrounding structures.