Cholesteatoma surgery by open technique with reconstruction together with same session ossiculoplasty

Ahmed Abdelmoneim Teaima,Mohammed Saad Hasaballah,Peter Milad,Ossama Mustafa Mady

doi:10.1186/s43163-021-00079-9

Ahmed Abdelmoneim Teaima, Mohammed Saad Hasaballah + Show 2 more

Open Access

https://doi.org/10.1186/s43163-021-00079-9

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Abstract

BackgroundThis study was designed to evaluate the effect of mastoid cavity obliteration with bone chips and reconstruction of canal wall with tragal cartilage after canal wall down tympanomastoidectomy with cartilage ossiculoplasty in the same session. Sixty-three patients with cholesteatoma underwent the technique mentioned above; patients were followed for 1 year postoperative.ResultsNo cavity problems, median preoperative air bone gap was 32.86 ± 6.24 db, while the median postoperative air bone gap was 21.67 ± 5.99 db.ConclusionsCanal wall down mastoidectomy with obliteration of mastoid cavity is an effective option for the complete removal of cholesteatoma and same session cartilage ossiculoplasty is a viable option.

Highlights

This study was designed to evaluate the effect of mastoid cavity obliteration with bone chips and reconstruction of canal wall with tragal cartilage after canal wall down tympanomastoidectomy with cartilage ossiculoplasty in the same session
canal wall up” (CWU) technique has its advantages of keeping intact anatomy avoiding cavity problems and better postoperative hearing results than canal wall down” (CWD) [6, 7], no
Twelve patients needed second-stage ossiculoplasty with Total ossicular replacement prothesis (TORP), eight of them due to failure of cartilage ossiculoplasty to improve their air bone gap (ABG), while four patients were planned because the middle ear depth was unsatisfactory for primary reconstruction cause of severe atelectasis

Summary

Introduction

This study was designed to evaluate the effect of mastoid cavity obliteration with bone chips and reconstruction of canal wall with tragal cartilage after canal wall down tympanomastoidectomy with cartilage ossiculoplasty in the same session. Cholesteatomas are expansile, erosive lesions of the middle ear and mastoid composed of keratinized squamous epithelium [1] Considered benign, their osteolytic activity and infectious nature result in significant complications as mastoiditis, ossicular erosion, hearing loss, dural sinus thrombosis, CSF otorrhea, meningitis, and intracranial abscess [2,3,4]. CWU technique has its advantages of keeping intact anatomy avoiding cavity problems and better postoperative hearing results than CWD [6, 7], no Reconstruction of the posterior canal wall after CWD surgery with or without obliteration of the mastoid seems to be a more appropriate solution combining low recidivism rate with a low ear discharge rate [10]. Several techniques of mastoid obliteration were suggested, using muscle flap [11, 12], cortical bone pate [11, 13], autogenous or allogenous bone chips [13, 14], silicone [15], and hydroxyapatite [12, 16]

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