Retrograde mastoidectomy with canal wall reconstruction with bone graft in acquired cholesteatoma

Yasser Shewel,Ahmed Abougabal

doi:10.1186/s43163-020-00005-5

Yasser Shewel, Ahmed Abougabal

Open Access

https://doi.org/10.1186/s43163-020-00005-5

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Journal: The Egyptian Journal of Otolaryngology	Publication Date: Jul 2, 2020
Citations: 2	License type: open-access

Affiliation: Alexandria University

Abstract

BackgroundThis study aimed to report the surgical outcomes of retrograde mastoidectomy with canal wall reconstruction using a bone graft that secured in place using glass ionomer cement (GIC) in adult patients with acquired cholesteatoma.ResultsThis study was conducted on 50 adult patients with acquired cholesteatoma who underwent retrograde mastoidectomy with a reconstruction of canal wall using a bone graft from the mastoid cortex. The preoperative and postoperative audiological evaluation was done; in addition, non-echoplanar (EPI) diffusion-weighted MRI was obtained at least 1 year postoperatively to detect recidivism of cholesteatoma.Recidivism of cholesteatoma was observed in 4/50 ears (8%) using diffusion-weighted MRI and confirmed during revision mastoidectomy. The audiological assessment showed a marked and statistically significant improvement of preoperative ABG from 30 to 21 dB in addition to the improvement of preoperative AC from 42 to 33 dB. ABG of 20 dB or less was achieved in 50% of the ears. No reaction occurred to GIC in all the ears.ConclusionsRetrograde mastoidectomy with canal wall reconstruction with bone graft was associated with a low rate of recidivism and significant improvement of the hearing. GIC is safe and effective in stabilization of bone graft in canal wall reconstruction.

Highlights

This study aimed to report the surgical outcomes of retrograde mastoidectomy with canal wall reconstruction using a bone graft that secured in place using glass ionomer cement (GIC) in adult patients with acquired cholesteatoma
Canal wall down (CWD) mastoidectomy has been performed since the end of the nineteenth century
Canal wall up mastoidectomy (CWU) was advocated by Antoni Candela in 1954 and described by Klaus Jansen in 1958 to overcome the previous drawbacks of open mastoidectomy, yet the closed technique is associated with a high rate of recidivism

Summary

Introduction

This study aimed to report the surgical outcomes of retrograde mastoidectomy with canal wall reconstruction using a bone graft that secured in place using glass ionomer cement (GIC) in adult patients with acquired cholesteatoma. Controversy exists in the literature regarding the management of cholesteatoma for many decades The focus of this debate is whether to perform open or closed techniques [1, 2]. Canal wall down (CWD) mastoidectomy has been performed since the end of the nineteenth century. This procedure entails the exenteration of the mastoid air cells with the removal of the posterior wall of the external canal. Preserving the posterior canal wall avoids open cavity problems it hampers proper visualization of hidden areas that are adequately exposed by open technique. Otologists concluded that preserving the posterior meatal wall increases the Shewel and Abougabal The Egyptian Journal of Otolaryngology (2020) 36:11 recidivism while its removal is associated with cavity problems [2, 3]

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