Abstract
Objectives The unique feature of cholesteatoma is the hyperproliferation and accumulation of keratin debris within the middle ear and mastoid cavity, a process that leads to destruction of the surrounding structures in the temporal bone. The proliferation of keratin and the resulting bony destruction in the cholesteatoma matrix are associated with apoptosis. FasL, when conjugated with Fas, is known to trigger apoptosis. This study aimed to analyze the temporal bone patterns in patients with cholesteatoma and the expression of FasL in the cholesteatoma matrix. Methods. From July 1999 to July 2001, all patients with cholesteatoma who received ear operations at the China Medical University Hospital were enrolled in this study. Surgical specimens from all patients were shown histopathologically to have cholesteatoma. The temporal bone patterns in these patients were reviewed by high resolution temporal bone computed tomography. Immunoperoxidase stain with a monoclonal antibody to FasL evaluated the expression of FasL in the cholesteatoma matrix. Postauricular skin, which was harvested during the same surgical procedure served as the control. Result& The temporal bone patterns in the patients were classified as blunted scutum (58%), ossicular chain erosion (58%), erosion of tegmen mastoid-tympanicum (30%), erosion of the otic capsule (25%) and marked sclerosis (50%). Expression of FasL was not detected in the postauricular skin, cholesteatoma matrix or subepidermal granulation tissue. Conclusions. The temporal bone patterns in the patients with cholesteatoma included bony destruction and new bone formation. No expression of FasL was detected in the cholesteatoma matrix or subepidermal granulation tissue. This indicates that apoptosis in the cholesteatoma matrix may not be through the FasL pathway. Therefore, the destruction of the temporal bone in patients with cholesteatoma may not be associated with FasL.
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