Eur Arch Otorhinolaryngol (2011) 268:67–72 DOI 10.1007/s00405-010-1349-1 123 OTOLOGY Management of petrous bone cholesteatoma: open versus obliterative techniques Fernando López Álvarez · Justo R. Gómez · Ma Jesús Bernardo · Carlos Suárez Received: 6 March 2010 / Accepted: 14 July 2010 / Published online: 3 August 2010  Springer-Verlag 2010 Abstract The objective of this study was to expose our results in the treatment of petrous bone cholesteatomas (PBC), paying attention to diagnosis, surgical strategy, facial management, results, and recurrences. The main objective is to compare the results of obliterative and open techniques in their management concerning the recurrence rate, due to the controversy elicited on obliterative or closed techniques in large cholesteatomas. A retrospective study was performed from July 1977 to September 2007 at the Tertiary referral cranial base center. Thirty-Wve patients were treated for PBC through diVerent surgical approaches, and in 25 cases (72%) the surgical cavity was obliterated with a muscle Xap. Four patients (11%) had a long-term recurrence. These patients received an open technique and after surgical re-exploration using a closed technique they had no recurrence. There were no recurrences in patients who underwent an obliterative technique and they received periodic MRI controls. The facial function after surgery was acceptable (71% of patients had House-Brackmann grades I to III). PBC is a complex pathology and presents diYculties in its diagnosis and treatment. Surgical tech- nique should be suitable for removing the pathology and preventing damage to structures such as the facial nerve or great vessels. Obliterative techniques, where possible, are at least as safe as open cavity procedures and they have fewer postoperative complications; however, regular fol- low-up with CT and MRI is mandatory. Keywords Petrous bone cholesteatoma · Open technique · Obliterative technique · Facial nerve · Recurrence Introduction Petrous temporal bone cholesteatoma (PBC) is a benign, slow-growing lesion located medial to the otic capsule. They represent an uncommon pathology and account for 4– 9% of all petrous pyramid lesions. PBC can be congenital, or more frequently, acquired, but histologically, both are indistinguishable. These lesions may remain clinically silent for many years and most of the time they invade the Fallopian canal and the labyrinth before they are diagnosed. The size, morphology, location, and the extratemporal spread of the disease are evaluated using diVerent imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT), to plan the surgical approach. DiVerent classiWcations of PBC have been proposed. In Sanna’s classiWcation [1], PBC are subdivided into Wve classes according to their relationship with the labyrinth (supralabyrinthine, infralabyrinthine, massive, infralabyrin- thine apical and apical). More recently, MoVat and Smith [2] established in 2008 a new system that includes lesions aVecting the petrous apex and intracranial extension (supralabyrinthine, infralabyrinthine, massive labyrinthine, F. L. Álvarez (&) Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, C/Marcos Peña Royo, 20–4ºA, 33013 Oviedo, Asturias (España), Spain e-mail: flopez_1981@yahoo.es J. R. Gómez · M. J. Bernardo · C. Suárez Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, C/Celestino Villamil s/n, 33008 Oviedo, Asturias (España), Spain C. Suárez Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain