Atypical presentation of an intradiploic epidermoid cyst

• Published in: Saudi medical journal 2019-06, Vol.40 (6), p.624-627
• Main Authors: Telmesani, Laila M, Aldriweesh, Bshair A
• Format: Article
• Language: English
• Subjects: Adult; Antibiotics; Bone Diseases - diagnostic imaging; Bone Diseases - pathology; Bone Diseases - surgery; Case reports; Cholesteatoma; Clinical Image; Cysts; Dental occlusion; Ears & hearing; Epidermal Cyst - diagnostic imaging; Epidermal Cyst - pathology; Epidermal Cyst - surgery; Female; Head; Hearing loss; Humans; Intraoperative Period; Magnetic Resonance Imaging; Medical diagnosis; Medical schools; Skin; Temporal Bone - diagnostic imaging; Temporal Bone - pathology; Temporal Bone - surgery; Tomography; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0379-5284; 1658-3175
• DOI: 10.15537/smj.2019.6.24166

A 31-year-old female patient with a history of right canal wall down mastoidectomy with meatoplasty for extensive primary acquired cholesteatoma at the age of 6 years, now presented with right ear pain, discharge, and trismus lasting for one month. Symptoms did not respond to medical treatment in another center in the form of a full course of both oral and ototopical antibiotics. On examination, there was a supra and preauricular well-demarcated firm swelling pushing the right auricle anteroinferiorly. The skin of the superior and anterior walls of the right external auditory canal was tender and edematous. There was discharge and granulation tissue emanating from the area of the temporomandibular joint (TMJ). We noted a bony defect in the same area as well as keratin flakes with suctioning. The mastoid cavity was lined by healthy skin and the middle ear by dry, healthy mucosa separated from the external auditory canal by a large central perforation in the tympanic membrane. There was no facial nerve weakness or objective sign of malocclusion. Upon these findings, we suspected that the patient’s otalgia and otorrhea arose as a result of the mass. Audiologic assessment revealed a right-sided, moderately severe conductive hearing loss with speech reception threshold at 55 dB, speech recognition score of 95%, and normal hearing in the left ear. Computed tomography of the temporal bone showed a soft tissue mass occupying the space between the 2 bony plates of the right squamous bone, with erosive changes of the outer and inner plates. There had been erosion of the middle fossa floor laterally and over the TMJ capsule (Figures 1A & 1B). Upon reviewing a CT that was obtained 2 years earlier, we noted an aeriated right squamous temporal bone with hypoplastic condyle and ramus of the mandible as well as a small intra-diploic soft tissue mass without bone destruction (Figure 1C).