[Cholesteatoma recurrences caused by intraoperative cell seeding? Contact endoscopic and cytologic studies].

Background: The high rate of recurrences of cholesteatomas after surgery is mostly caused by insufficient removal of matrix. Another factor may be intraoperative scattering of matrix cells e. g. with the running burr, which later may become the origin of new cholesteatoma growth. In this paper we tried to visualize these cells for gaining further informations.

Patients And Methods: In 10 patients intraoperative contact endoscopy of the cholesteatoma was carried out during mastoidectomy. After intravital staining with methylene blue the very superficial tissue layers can directly be considered via a contacting endoscope. In addition, sucked-off rinsing fluid was cytologically examined for epithelial cells.

Results: Both investigations show only very rare vital squamous cells - besides other cells like or ciliated cells and foreign body giant cells.

Discussion And Conclusions: Inspite of their small number, these squamous cells in principle could cause dispersed growth of cholesteatoma. However, this seems to be much less significant than the assumption of matrix left behind intraoperatively. The danger of dispersed cell growth can further be diminished by adequate operating techniques with sufficient rinsing, smoothing the bony cavity walls and avoiding blind corners.