Pediatric Modified Radical Mastoidectomy: Open Cavity versus Periosteal-Temporofascial Flap Obliteration: An Analysis

Abstract

Obliteration of the mastoid cavity leaves a smaller cavity with quicker as well as better healing. Chances of developing cavity granulations or infection are also reduced. Protection of the lateral semicircular canal by soft tissue obliteration also prevents vertigo episodes on exposure to cold air. This prospective study was to compare the results of pediatric modified radical mastoidectomy (MRM) in open mastoid cavities and cavities obliterated with periosteal-temporofascial swing flap at Manipal Teaching Hospital, Pokhara; a tertiary referral centre. The cohort comprised of 40 pediatric patients who underwent MRM between January 2012 and December 2014. They were divided into group 1 where mastoid cavity was kept open and group 2 where mastoid cavity was obliterated with periosteal-temporofascial swing flap plus medicated bone dust. Results in the 2 groups were assessed by comparing the time taken for mastoid cavity to become dry, incidence of vertigo on exposure to cold air, tympanic membrane graft status, mastoid cavity status and change in the pre-operative to post-operative pure tone average after 6 months. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0. Statistical significance was set at p<0.05. Group 1 vs. Group 2 results were as follows: Mean time taken for mastoid cavity to dry was 81.8 days vs. 30.1 days. Vertigo on exposure to cold air was present in 77.3% vs. 0%. Tympanic membrane graft status was intact in 72.7% vs. 100%. Mastoid cavity epithelialization was complete in 68.2% vs. 94.4%. Mastoid cavity granulations were present in 36.4% vs. 5.6%. Mastoid cavity healing rates were 63.6% vs. 94.4%. Residual cholesteatoma was seen in 4.5% vs. 0%. Excessive wax & keratin debris was present in 36.4% vs. 5.6%. External auditory canal opening was adequate in 86.4% vs. 94.4%. The mean post-operative pure tone average was 37.61 dB vs. 25.97 dB. Mean gain in pure tone average was 8.94 dB vs. 19.84 dB. None of the patients developed intra-cranial complications. Periosteal-temporofascial swing flap plus medicated bone dust obliteration of pediatric MRM cavity provides a dry and healed cavity in less time with better hearing when compared to an open MRM cavity.