Temporal bone fractures and cholesteatoma.

Extralabyrinthine fractures of the temporal bone offer the opportunity for squamous epithelial invasion of the middle ear, petrous pyramid, and mastoid air-cell system as a late complication. Cholesteatoma, secondary acquired in this situation, can be very aggressive and difficult to manage surgically, particularly where the temporal bone air-cell system is well developed. Polytomography is extremely helpful in determining the sites of fracture and in fashioning the surgical approach. Three cases are presented to illustrate the problems in diagnosis and surgical management.