Temporal Bone Cholesteatoma Presenting With Chronic Facial Nerve Palsy: A Case Report With Radiological Correlation.

Temporal bone cholesteatoma may present atypically, including cases that lead to isolated facial nerve palsy. We report a 72-year-old man with an eight-month history of stable right-sided lower motor neuron facial weakness. Examination demonstrated House-Brackmann grade III facial nerve palsy. Imaging revealed a lesion involving the right mastoid and jugular bulb with bony erosion and diffusion restriction on MRI, consistent with cholesteatoma. The case was discussed at a regional skull base multidisciplinary team meeting, and subtotal petrosectomy with blind sac closure was planned. This case highlights the importance of imaging in persistent facial palsy and multidisciplinary decision-making in advanced temporal bone disease.