Cholesteatoma recurrences caused by intraoperative cell seeding? Contactendoscopic 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 int raoperativ scattering of matrix cells e.g. with the running burr, which lat er may become the origin of new cholesteatoma growth. In this paper we trie d to visualize these cells for gaining further informations. Patients and M ethods: In 10 patients intraoperative contact endoscopy of the cholesteatom a was carried out during mastoidectomy. After intravital staining with meth ylene blue the very superficial tissue layers can directly be considered vi a a contacting endoscope. In addition, sucked-off rinsing fluid was cytolog ically examined for epithelial cells. Results: Both investigations show onl y very rare vital squamous cells - besides other cells like or ciliated cel ls and foreign body giant cells. Discussion and Conclusions: Inspite of the ir small number, these squamous cells in principle could cause dispersed gr owth of cholesteatoma. However, this seems to be much less significant than the assumption of matrix left behind intraoperativly. The danger of disper sed cell growth can further be diminished by adequate operating techniques with sufficient rinsing, smoothing the bony cavity walls and avoiding blind corners.