Dissemination of squamous papilloma by surgical manipulation: a case report.

The occurrence of multiple squamous cell papilloma in the upper and lower aerodigestive tract is well documented. While apparent inoculation to other areas in the lower respiratory tract at the time of bronchoscopy or tracheotomy is a frequently described occurrence, there have, however, been no reports of transmission of papilloma outside the respiratory tract as a result of surgical manipulation. The purpose of this paper is to report a case of squamous papilloma of the external auditory canal and tympanic membrane which resulted from apparent inoculation at the time of surgery for nasal cavity and nasopharyngeal papillomas together with myringotomies. This supports the hypothesis that an infectious agent, e.g., a virus could be the causative agent and that inoculation to other sites as a result of manipulation is possible. In light of our experience with this case we recommend specific guidelines for the handling of these patients and the protection of surgeons, anesthesia and operating room personnel. Hopefully this report will heighten awareness of papillomas as a potentially transmittable entity to sites outside the respiratory tract, and encourage others to approach these clinical situations with caution.