In the management of cholesteatoma with facial nerve dehiscence discovered intraoperatively, the most appropriate initial step is to:

• A Remove the cholesteatoma matrix completely from the nerve sheath
• B Biopsy the nerve sheath and close the ear
• C Leave the cholesteatoma matrix over the dehiscent nerve and stage the procedure ✓
• D Cover the nerve with a fat graft and proceed with complete removal

Explanation

When cholesteatoma matrix overlies a dehiscent facial nerve, aggressive removal risks iatrogenic facial nerve injury. The standard approach is to leave the matrix over the nerve (a 'second-look' procedure is planned) rather than risk nerve damage. Staged surgery with imaging surveillance is preferred. This principle balances oncologic control with functional preservation.

Reference: Cummings Otolaryngology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.