Summary Staged tympanoplasty in the treatment of cholesteatoma : prevention of postopera tive retraction pocket

Abstract

In the treatment of cholesteatoma employing intact canal wall tympanoplasty staging the operation has been employed to re-establish aeration of the middle ear and to eradicate possible causes of recurrence, cholesteatoma residue and retraction pocket. The paper describes the surgical procedures evolved by the authors to prevent postoperative retraction pocket. At the first stage operation following three procedures are important to re-establish aeration of the tympanic cavity ; 1) widening of the tympanic isthmus with posterior hypotympanotomy in conjunction with removal of the incus and the head of the malleus, 2) scutum plasty with use of bone pate and 3) placement of a silastic sheet in the tympanic cavity. At the second stage operation, one of the following three types of operations is performed according to the grade of aeration of the tympanic cavity : type S-1, only ossiculoplasty ; type S-2, ossiculoplasty and scutum plasty ; and type S-3, ossiculoplasty, scutum plasty and mastoid obliteration. Details of the surgical technics were described together with some of the results of long term follow-up study. Emphasis was placed on the importance of long term follow-up examinations with aid of operation microscope and CT.