title: Histopathological evaluation and long-term results of soft tissue preservation technique in cholesteatoma surgery.
abstract: The goal of cholesteatoma surgery is total removal of the cholesteatoma matrix and prevention of recurrence. Preservation of soft tissue in the attic is reported to improve post-operative middle ear aeration, and thus prevents recurrence. However, the histology and nature of the preserved tissue have rarely been reported. The aim of this study is to clarify the histology of the preserved soft tissue in cholesteatoma surgery, and to show its relationship to the clinical course. Surgical specimens were obtained from ten patients with pars flaccida-type cholesteatoma. In these patients, cholesteatoma occupied the attic and the mastoid cavity. The cholesteatoma was removed so as not to expose the bone in the attic. After the removal of the lesions, soft tissue was harvested from the floor of the attic, using cupped forceps. The specimens were fixed with 10 % formalin, and stained with hematoxylin-eosin. The patients were followed-up for 8 years after the surgery. No patients showed post-operative inner ear disturbance or facial nerve palsy. In one patient, residual lesion was found during the revision surgery. The area of residual lesion was not explored during the first operation. Two other patients showed recurrent cholesteatoma in the pars tensa; one of these patients had accompanying otorrhea. The other seven patients showed no residual or recurrent cholesteatoma 8 years after the surgery. The histological examination showed that the harvested tissue was mainly composed of collagen fiber and fibroblasts. Ciliary epithelial cells were found in one patient. In three patients, cysts of mucosal remnants (glandular cysts), were embedded in the connective tissue. Two of these three patients experienced recurrent cholesteatoma, while the other seven patients were without recurrence at follow-up. Preservation of soft tissue behind the cholesteatoma matrix is a safe technique if the surgical field is fully visible. In most cases, the preserved tissue was fibrous connective tissue and lacked the characteristics of mucosa. The glandular cysts in the preserved soft tissue seem to be related to the recurrence of cholesteatoma.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505, Iwate, Japan. hhiraumi@iwate-med.ac.jp.|Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. hhiraumi@iwate-med.ac.jp.
authors.forename: Harukazu
authors.identifier: http://orcid.org/0000-0002-0254-5261
authors.initials: H
authors.lastname: Hiraumi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kitano Hospital, Osaka, Japan.
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Kanemaru
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wakayama Red Cross Hospital, Wakayama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Miura
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Division of Hearing and Communication Medical Center, Shiga Medical Center for Adults Research Institute, Shiga, Japan.
authors.forename: Juichi
authors.initials: J
authors.lastname: Ito
mesh_terms: D000328:Adult; D000368:Aged; D018424:Cholesteatoma, Middle Ear / Q000473:pathology* / Q000601:surgery*; D003094:Collagen; D003560:Cysts / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D005347:Fibroblasts / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D014021:Tissue Preservation; D055815:Young Adult
chemical_list: D003094:Collagen
keywords: Cholesteatoma; Glandular cyst; Mastoidectomy; Perimatrix; Tympanoplasty