[Cholesteatomas of the fronto-orbital region].

Three cases of primary fronto-orbital cholesteatoma are reported and the relevant ORL and neurosurgical literature reviewed. Clinical diagnosis of this rare affection is not simple but is suggested by signs of infero-internal exophthalmus, an external orbital mass or exteriorized sinusitis after chronic headache. Two characteristic features are seen on radiology. The essential therapeutic problem is to prevent late recurrences, their frequency appearing to have been underestimated. Secondary cholesteatoma of iatrogenic or post-traumatic development is seen more rarely, and produces an endosinus disease treated surgically through a conventional para-lateronasal approach. Primary cholesteatoma, the more common variety, originates in the frontal diploë, is perisinusal in location and can extend into neighboring structures, particularly the external orbital apophysis. A CT Scan is essential in order to detect endocrine extension. A surgical approach adapted to the perisinusal localization of the lesion must be adopted, as for example the Cairns-Unterberger approach.