DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20221394

Iatrogenic seeding of cholesteatoma in rare planes

Cameron Todd, Brian Downs, Michele Gandolfi

Abstract


A cholesteatoma is a cystic lesion of keratinizing stratified squamous epithelium commonly found in the middle ear space. Acquired cholesteatomas are often caused by seeding of squamous epithelium into the middle ear space during surgery. We present a 29-year-old male who had a left tympanomastoidectomy and then staged second look with ossicular chain reconstruction for cholesteatoma 6 years prior to presenting with a left pre and post-auricular mass measuring 8.2×2.9×6 cm. He underwent combined surgical excision with facial plastic surgery and neuro-otology. He was found to have cholesteatoma extending from a defect in the mastoid cavity into the pre-auricular and post-auricular soft tissue. This was felt to be recurrent disease seeded from his initial surgery. To our knowledge, we present the largest iatrogenic cholesteatoma reported in the literature. It had explosive growth in a relatively short time period with extension into an unusual location due to presumed iatrogenic causes. Our case highlights the potential to seed cholesteatoma in previously disease-free areas when performing cholesteatoma surgery. It also demonstrates the aggressive nature of pediatric cholesteatomas, and is in line with the literature in that regard. The case enforces the extreme care that needs to be taken when performing cholesteatoma surgery to ensure that disease is not introduced in areas of the head and neck. It also stresses the importance of close, long term follow up for pediatric cholesteatoma given the potential for aggressive reoccurrence and growth.


Keywords


Otology, Neurotology, Cholesteatoma, External ear

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References


Semaan MT, Megerian CA. The pathophysiology of cholesteatoma. Otolaryngol Clin North Am. 2006;39(6):1143-59.

Persaud R, Hajioff D, Trinidade A, Khemani S, Bhattacharyya MN, Papadimitriou N, Kalan A, Bhattacharyya AK. Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatoma. J Laryngol Otol. 2007;121(11):1013-9.

Vella JB, Wackym PA, Wang H, Roychowdhury ST. Iatrogenic Cholesteatoma Presenting as Neck Mass. Laryngoscope. 2021;131(3):882-4.

Sweeney AD, Hunter JB, Haynes DS, Driscoll CL, Rivas A, Vrabec JT, Carlson ML. Iatrogenic cholesteatoma arising from the vascular strip. Laryngoscope. 2017;127(3):698-701.

Ungar OJ, Cavel O, Wasserzug O, Oron Y, Locketz GD, Handzel O. Iatrogenic cholesteatoma originating from a misplaced tympanomeatal flap during tympanoplasty: a series of five patients. Eur Arch Otorhinolaryngol. 2020;277(12):3295-9.

Dornelles Cde C, da Costa SS, Meurer L, Rosito LP, da Silva AR, Alves SL. Comparison of acquired cholesteatoma between pediatric and adult patients. Eur Arch Otorhinolaryngol. 2009;266(10):1553-61.

Azevedo AF, Soares AB, Garchet HQ, Sousa NJ. Tympanomastoidectomy: Comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media. Int Arch Otorhinolaryngol. 2013;17(3):242-5.

Glasscock ME, Miller GW. Intact canal wall tympanoplasty in the management of cholesteatoma. Laryngoscope. 1976;86(11):1639-57.

Sanna M, Zini C, Scandellari R, Jemmi G. Residual and recurrent cholesteatoma in closed tympanoplasty. Am J Otol. 1984;5(4):277-82.

Sheehy JL, Brackmann DE, Graham MD. Cholesteatoma surgery: residual and recurrent disease. A review of 1,024 cases. Ann Otol Rhinol Laryngol. 1977;86(4):451-62.