Patient: A 55-year-old man with sudden onset of weakness on the right side of his face.
Diagnosis: A congenital disease called congenital extradural CP angle petrous apex cholesteatoma.
Notes: Timely intervention saved the patient’s life. It was drained in the first stage.
Doctor: Dr Samir Joshi, Professor and Head, ENT department, B J Government Medical College and Sassoon General Hospital, Pune
Life is a series of blind corners…it springs surprises at you every now and then. The field of medicine is no exception, but the surprises here are often life-threatening for the patient.
Ramdas (name changed) was a 55-year-old farmer with two young daughters. Six months ago, he experienced a sudden onset of weakness on the right side of his face.
When he was a child, he had suffered from purulent ear disease in his left ear.
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Apparently, the 55-year-old man did not notice that he had completely lost his ability to hear in the right ear, possibly because the problem was a long-standing one.
It had not been detected by cursorily-performed audiometry test without masking. He visited many places for his deviated face, but it was treated as a common viral illness, the ‘Bell’s palsy’.
But when his condition did not improve even after six months, he consulted doctors at the ENT department of the Sassoon government hospital in Pune.
A carefully conducted audiometry test revealed that he was completely deaf in his right ear and the subsequent CT scan showed a mass in Cerebello-pontine angle region inside the skull cavity.
This is a congenital mass which had remained inside his skull for a period of 54 years and was likely to have killed him sooner, rather than later.
After a subsequent difficult surgery was performed on him, it was found to be a congenital disease called congenital extradural CP angle petrous apex cholesteatoma!
Cholesteatoma is an expansile lesion (very much like a tenant in your house who wants to ultimately dislodge the real owner). It causes bone erosion as well as affects important structures in the proximity by mass effect leading to serious complications. Surgery remains the definitive treatment of petrous apex cholesteatoma.
Because of the location of petrous apex and proximity of vital structures, the surgery of petrous apex cholesteatoma becomes a surgical challenge. When it starts to get infected or bursts open the dura – that is the covering of the brain — it can spell doom for the patient.
But in this case, timely intervention saved the patient’s life. It was drained in the first stage and in the second stage, a facial reanimation surgery was planned for him.
It is often said that experience is more important than mere bookish knowledge. It is most applicable to doctors and this has been my most curious case.