Due to the increased incidence of motor vehicle accidents, the modern man is faced with an increasing problem of basal skull fracture. Cholesteatoma can develop as a late complication of the temporal bone fracture. Callus formation in extralabyrinthine fractures produces a barrier to the ingrowth of the epithelium of the external auditory canal. However, an entrapment of epithelium prior to callus formation, complex displacement of bony fragments, diasthesis of suture lines, or tears of the tympanic membrane will all permit favorable foci for post-traumatic cholesteatoma formation. Cholesteatoma, secondary acquired in these situations, can be very aggressive and difficult to manage surgically, particularly where the temporal bone air-cell system is well developed. We recently experienced a case of post-traumatic cholesteatoma in a 47 year-old-male patient who had a history of temporal bone fracture prior to admission.