Combined grafts in total reconstruction of old radical cavities.

Abstract

93 patients with an old, infected and discharging radical cavity were subjected to total reconstruction of the middle ear, especially to obtain a permanently dry ear. The cavity was obliterated and the auditory meatus reconstructed by various muscle grafts and large pieces of fascia (41 ears), by combined grafts consisting of tragal cartilage, pieces of bone, homologous septal cartilage, and muscle grafts (40 ears). In the 12 prognostically most favourable ears the cavity was repneumatized. The functional results were the same in all three groups, namely a functional success in 72%. At follow-up 1-6 years after the operation there was functional success in 62%, but 94% of the ears were dry. Obliteration of the cavity by combined grafts was at long sight more solid than obliteration by muscle. It is discussed whether, in reconstructing radical cavities, repneumatization of the cavity is preferable to obliteration, and it is concluded that at long sight a solid obliteration must afford a more stable ear than repneumatization.