Iatrogenic cholesteatoma arising from the vascular strip.
To highlight the phenomenon of cholesteatoma arising from the vascular strip following tympanoplasty and tympanomastoidectomy.



Multi-institutional retrospective chart review.



Consecutive adult and pediatric patients evaluated between 2000 and 2015 with acquired cholesteatoma arising from the skin of a prior vascular strip were identified. Patients with evidence of residual or recurrent cholesteatoma elsewhere in the middle ear, mastoid, or ear canal were excluded.



Seventeen cases (71% female, 53% right-sided) were identified, and the mean age at presentation was 39.2 years. Patients presented on average 12.9 years following prior otologic surgery, which was most commonly tympanoplasty without mastoidectomy (59%). However, younger patients presented with symptoms sooner following prior surgery (r = 0.61, r2= 0.37, P = 0.0095). The most common presenting symptom was otorrhea (76%). All patients were found to have mastoid cholesteatoma with bony erosion, and three patients exhibited additional tegmen or posterior fossa bone defects. The middle ear was not involved with cholesteatoma in any case. A canal wall down procedure was performed due to extensive bony canal erosion in 29% of cases.



The vascular strip is an uncommon source of iatrogenic cholesteatoma that can present years following an otherwise uncomplicated otologic surgery. The findings presented herein highlight the importance of careful vascular strip orientation at the conclusion of otologic surgery.



4. Laryngoscope, 127:698-701, 2017.
Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
Alex D
AD
Sweeney
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Jacob B
JB
Hunter
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.|Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
David S
DS
Haynes
Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
Colin L W
CL
Driscoll
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Alejandro
A
Rivas
Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
Jeffrey T
JT
Vrabec
Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
Matthew L
ML
Carlson
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008416:Mastoid / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000098:blood supply* / Q000473:pathology; D014433:Tympanoplasty / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult
Otology; cholesteatoma; iatrogenic; temporal bone; tympanomastoidectomy; tympanoplasty; vascular strip