Learning Objectives: Petrous Bone Cholesteatomas with extensions to the sphenoid sinus are rare and pose a surgical challenge. Here we describe a unique case of a 54 year old male patient with a Massive Petrous Bone Cholesteatoma (according to the Sanna classification) extending upto the sphenoid sinus. This was excised using a Modified Transcochlear Approach (with posterior re-routing of the facial nerve) and the cavity was closed by abdominal fat with a blind sac closure of the external auditory canal. The patient is free of disease after a 4 year follow-up.
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