Fibrous dysplasia with unsafe ear

Curious case of pearloma !😊
     Life is full of surprises ! Recently a case was referred by neurosurgeon with severe ear pain , stenosed ear canal and with the above CT findings😱. A case of fibrous dysplasia with temporal bone invo




lvement and huge expanded mastoid cavity and petrous temporal bone.
     First of this kind of experience😒. Nevertheless took the case for decompression of the lesion . It was huge skull due to expansion, Changed the routine of endaural to postural incision. The bone of mastoid was like ping pong ball and almost non existing ear canal because of anteriorly collapsed post canal wall. Little drilling and cavity opened with pus and debri and then in between pearls of none other than our old aquaitance as if saying 'Hey ! Get me out of hear if you want relief for your pt and your self😉. Inferiorly dehiscent jugular and a closed cavity with collapsing walls on all sides    with only suction doing the job like in soft pituitary tumors. The cavity extending deep posteriorly with debri coming out and eventually non traceable  with microscope😇, so services of endoscopes  had to be availed 👍 to clear the depth. Wide meatoplasty and closure in the end.
      It was none other than the old enemy of our pts🤨. Taken many lives in the past but has provided bread and butter to all of us 😊and food for thought, research material for  academics for years🤔 and I am sure must have been one of the topics for discussion in Sunday's CME and panel discussion🤗.
     Disturbed physiology and mechanics of middle ear  and this pearloma  will  acquire the space otherwise  unambiguously it is congenital variant😞.
       I know you got it, it was none other than 'cholesteatoma'🙏. Please forgive me👏 for my misadventure🤏 of dramatization. Don't forget to give your inputs👍

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