Clin Exp Otorhinolaryngol.  2015 Sep;8(3):230-236. 10.3342/ceo.2015.8.3.230.

Obliteration of Radical Cavities and Total Reconstruction Procedure Without Staging After Canal Wall Down Mastoidectomy: Long-term Results

• Liu SC
• Wang CH
• Huang BR

• KMID: 2117517
• DOI: http://doi.org/10.3342/ceo.2015.8.3.230

Abstract

OBJECTIVES
We evaluate the long-term surgical and hearing results using a canal wall down mastoidectomy technique followed by cavities obliteration, canal wall reconstruction and ossiculoplasty without staging.
METHODS
A total of 44 patients between January 2002 and October 2009 were selected and 27 of them were revision cases. Preoperative and postoperative pure tone average (PTA) and air-bone gap (ABG) were assessed and compared 1 and 4 years after surgery.
RESULTS
The middle ear was well healed and aerated in 40 patients (90.9%) and the tympanic membrane was intact in 42 patients (95.5%). Recurrent cholesteatoma was found on postoperative follow-up in two of the revision patients (7.4%) but none in the primary patients. Seven patients were found to have partial canal bone absorption, but revision surgery was not required. Over 86.4% of all cases were water resistant. Long-lasting improvement and/or preservation of hearing, with maintenance of PTA-ABG closure in 63.7% of all cases within 20 dB, were obtained.
CONCLUSION
The efficacy of our technique after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method in disease control and providing an excellent basis for hearing restoration simultaneously.

Keyword

Cholesteatoma; Mastoid; Surgical Procedures, Operative; Reconstructive Surgical Procedures; Hearing

MeSH Terms

Absorption
Cholesteatoma
Ear, Middle
Follow-Up Studies
Hearing
Humans
Mastoid
Reconstructive Surgical Procedures
Surgical Procedures, Operative
Tympanic Membrane
Water
Water

Figure

• 

  Fig. 1 Schematic figures of operating technique. (A) An endoaural incision was made as Heermann B incision. (B) A superiorly meatal pedicle flap (SMPF) about 15-mm width and 25- to 30-mm length was designed and elevated. (C) A free bone-connective tissue composite graft (BCCG, white arrow) was harvested (black arrowhead, anterior buttress; white arrowhead, posterior buttress). IBCBF, inferiorly based conchal bowl flap.

• 

  Fig. 2 Schematic figures of operating technique. (A) The posterior bone canal wall is reconstructed with the bone-connective tissue composite graft (white arrow). (B) The cavities are obliterated with bone chips and pâté, using the parallel overlapping stacking method. (C) The superiorly meatal pedicle flap (white bifid tail arrow) is shielded the surface of the obliterated cavity. (D) The ossicle chain and eardrum is reconstructed without staging (black arrow, inferiorly based conchal bowl flap; black bifid tail arrow, tympanomeatal flap; black arrowheads, split-thickness skin grafts).

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