14 - Canal Wall Reconstruction Tympanomastoidectomy

Abstract

The primary goal in the surgical management of chronic otitis media with cholesteatoma is the creation of a dry, safe ear through removal of disease and the alteration of anatomy to prevent recurrence. This goal can be accomplished effectively with preservation [canal wall-up (CWU)] or removal [canal wall-down (CWD)] of the posterior canal wall (PCW), both described in previous chapters. In this chapter we describe the technique of canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration. CWR tympanomastoidectomy combines elements of the CWU and CWD procedures to optimize surgical exposure for removal of disease, and it creates a blockage of the attic that prevents the recurrence of retraction pockets and cholesteatomas. Many authors have described reconstruction of the PCW and mastoid obliteration using a variety of methods, including composite osteoperiosteal flaps,1 composite cartilage-titanium grafts,2 ceramic alloplasts,3-7 bone pâté,8-10 costal cartilage,11 and bone cements.12-14 CWR tympanomastoidectomy with mastoid obliteration, similar to the procedure described in this chapter, was originally described by Mercke in 1987.15 Important modifications to the Mercke technique have been published by Gantz et al.16 and are described in detail in this chapter. The long-term results of using the technique in 272 children and adults have been published.17