mastoid obliteration operationData included mastoid cavity status, results at second-look surgery with ossiculoplasty, and postoperative complications. All patients underwent second-look surgery. Chronic otitis media COM with cholesteatoma is running dbol by itself common disease in otology. The principal goal in cholesteatoma surgery is the complete eradication of the disease to produce a mastoid obliteration operation, safe and self-cleaning ear and creation of new anatomy to prevent recurrence. Canal wall up Mastoid obliteration operation techniques have many advantages such as preserving the posterior canal wall, eliminating the need for periodic bowl cleaning, avoiding the risk of recurrent bowl infections, and simplifying ossicular reconstruction.
Mastoid cavity obliteration | Cholesteatoma | Patient
Data included mastoid cavity status, results at second-look surgery with ossiculoplasty, and postoperative complications. All patients underwent second-look surgery. Chronic otitis media COM with cholesteatoma is a common disease in otology. The principal goal in cholesteatoma surgery is the complete eradication of the disease to produce a dry, safe and self-cleaning ear and creation of new anatomy to prevent recurrence.
Canal wall up CWU techniques have many advantages such as preserving the posterior canal wall, eliminating the need for periodic bowl cleaning, avoiding the risk of recurrent bowl infections, and simplifying ossicular reconstruction. Canal wall down CWD mastoidectomy is a well-established surgical technique used to completely remove cholesteatoma. The advantages of CWD mastoidectomy include excellent exposure of the entire attic and middle ear and complete eradication of disease.
However, this technique has some disadvantages, such as accumulation of debris in the exteriorized mastoid cavity, a requirement for periodic cleaning and water restrictions to prevent bowl infection, and problems relating to ossicular reconstruction, non-aesthetic meatoplasty, reports of vertigo in cold weather and during swimming, and difficulty with fitting a hearing aid 1 , 2. Recently mastoid obliteration has been used in CWU tympanoplasty for cholesteatoma to facilitate tympanic aeration and ultimately to prevent future recurrence of cholesteatoma 3.
The principal advantages of mastoid cavity obliteration are 1 reduced nitrogen-absorbing mucosa in the mastoid cavity preventing recurrence of retraction cholesteatoma in patients with eustachian tube dysfunction, 2 elimination of mastoid cavity preventing accumulation of squamous epithelium and bowel infection 1 - 3.
The size of the surgical cavity can be diminished using obliteration to create a small cavity that is self-cleaning and easily maintained. Both autologous and synthetic materials have been used for obliteration. In this study we obliterated the mastoid cavity with bone pate and a Palva flap. This communication describes the surgical technique, results, and management of complications. A prospective longitudinal study of patients who underwent CWD mastoidectomy between — at the Tabriz University of Medical Sciences, Iran was performed.
All procedures were performed by the author. A database was designed to record pertinent data including age, sex, postoperative status of the mastoid cavity, tympanic membrane and findings at second-look surgery including presence of residual disease.
Occurrence of operative cavity pathology and recurrence of cholesteatoma were recorded. The procedure was performed under general anesthetic using a postauricular approach. Bone pate was then mixed with antibiotic and steroid and set aside Fig. A complete mastoidectomy with removal of posterior wall was performed Fig. The cholesteatoma sac, pathologic mucosa, incus, malleus head and tensor fold were removed. A flask-shaped tear drop of silastic sheeting 0. A large fresh temporalis fascia graft was used in an underlay fashion to reconstruct the tympanic membrane.
A small meatoplasty was then performed to promote healing and self-cleaning of the new reconstructed wide external canal. The Palva flap was placed into the mastoid cavity, over the temporalis facia graft, and the Korner flap was placed on top. The external auditory canal was packed with Gelfoam and rosebud.
A quarter-inch Penrose drain was placed lateral to the obliterated mastoid cavity and the wound was closed using Vicryl subcutaneously in one layer, and a standard mastoid dressing was applied. Intravenous antibiotic Cefteriaxone was administered continuously for 48 hours and intramuscularly for another 5 days.
Patients used oral Cefixime to complete the day course. The Penrose was removed on Day 2 following surgery. The mastoid dressing was changed daily until discharge, and the rosebud was removed after 14 days. Second-look surgery with ossiculoplasty was performed, typically after 6 months among adults and 12 months in children after the initial tympanomastoidectomy. During second-look surgery, the status of the mastoid cavity, and tympanic membrane graft were assessed. The middle ear was investigated for the presence of residual cholesteatoma, and ossicular reconstruction was performed.
Fifty-six ears in 48 adult and children were subjected to CWD mastoidectomy with mastoid cavity obliteration. Eight patients had bilateral surgeries performed on different occasions. The mean postoperative follow-up time was 28 months. In all patients there was ossicular destruction that required reconstruction. Second-stage surgery was performed in all patients for detection of cholesteatoma recurrence and for ossicular reconstruction.
Unlike CWU techniques, traditional CWD techniques involving removal of the posterior canal wall improves exposure and facilitates the complete removal of all cholesteatoma. However, despite the fact that most well-constructed mastoid cavities remain problem-free, they do require periodic cleaning and are prone to bowl infection. Preservation of the posterior canal wall results in a higher rate of recidivism, particularity in children, while CWD techniques also provide for removal nitrogen-absorbing mucosa of the mastoid.
After surgery, the new epithelial lining of the mastoid bowl is stratified keratinizing epithelium 1. Mastoid cavity obliteration could reduce problems of a large mastoid cavity. The greatest advantage of this technique is its technical simplicity. In this procedure, a combination of biologic graft and local flap is used. The Palva flap, in turn, provides a suitable vascular bed to allow regrowth of skin from the Korner flap to the new reconstructed mastoid cavity.
The early resolution of the wound is another advantage of this combined procedure. A Palva flap in the mastoid cavity prevents exposure of the obliterated material and necrosis of posterior canal wall Korner flap skin. Hormann et al reported lower a reduced risk of epithelization and Takahashi et al documented a higher percentage of exposure of obliterated material when an apatite ceramic was used 22 , When muscular flaps are used alone to obliterate the mastoid cavity, the muscle becomes atrophied and the mastoid cavity becomes larger.
The only limitation associated with mastoid obliteration is the requirement for the surgeon to ensure complete removal of the cholesteatoma matrix from the mastoid cavity. The only complication encountered using this technique was postoperative wound infection when intravenous antibiotics were used for 2 days. All infections occurred among the first patients to undergo the procedure. No cases of postoperative infection were observed under the modified protocol. This procedure has been successful in cases of cholesteatoma complicated with lateral semicircular canal fistula.
Using a small meatoplasty, the newly formed mastoid cavity has provided sufficient draining and aeration, an improved aesthetic appearance, and the provision for a hearing aid to be fitted comfortably. However, long-term follow-up ideally for 10 years will be needed in order to investigate the occurrence of residual cholesteatoma under the obliteration material or tympanic membrane retraction. In modern ear surgery, mastoid cavities due to CWD mastoidectomy are obliterated using various techniques and materials.
In our experience, this procedure is an effective method to manage patients with pre-existing mastoid cavities and also those not previously operated upon. The outcome in all cases was a safe, dry, and self-cleaning ear.
The author wishes to express his gratitude and special thanks for the insight of Miss. National Center for Biotechnology Information , U.
Journal List Iran J Otorhinolaryngol v. Received Jan 27; Accepted Jun Introduction Chronic otitis media COM with cholesteatoma is a common disease in otology. Surgical Technique The procedure was performed under general anesthetic using a postauricular approach.
Open in a separate window. Results Fifty-six ears in 48 adult and children were subjected to CWD mastoidectomy with mastoid cavity obliteration. Table 1 Patient Demographics. Discussion Unlike CWU techniques, traditional CWD techniques involving removal of the posterior canal wall improves exposure and facilitates the complete removal of all cholesteatoma.
Conclusions In modern ear surgery, mastoid cavities due to CWD mastoidectomy are obliterated using various techniques and materials. Acknowledgment The author wishes to express his gratitude and special thanks for the insight of Miss.
Canal wall reconstruction tympanomastoidectomy with mastoid obliteration. Mastoid obliteration with Silicone blocks after canal wall down mastoidectomy. Clinical and Experimental Otorhinolaryngol. Total mastoid obliteration in staged canal-up tympanoplasty for cholesteatoma facilitates tympanic aeration. Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket.
Estrem SA, Highfill G. Otolaryngol Head Neck Surg. Mastoid obliteration and reconstruction: A review of techniques and results. Proceeding of Singapore Healthcare. Surgical treatment of chronic middle ear disease. Canal wall up and canal wall down procedures. Maniu A, Cosgarea M. Mastoid obliteration with concha cartilage graft and temporal muscle fascia.
Deep temporalis fascia in tympanomastoid reconstruction. Afr J Med Med Sci. Mastoid obliteration combined with soft-wall reconstruction of posteriorear canal. Mastedoctomy oblitration with bioactive glass: Long-term outcome of the Hong Kong vascularized, pediceled temporalis fascia flap in reconstruction of mastoid cavity. Singh V, Atlas M. Obliteration of the persistently discharging mastoid cavity using the middle temporal artery flap.
The use of the temporoparietal fascial flap in temporal bone reconstruction. Olson KL, Manolidis S. The pedicled superficial temporalis fascia flap: Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall down tympanomasto- idectomy.