Mastoid Cavity Obliteration Research Articles

Management of labyrinthine fistula in middle ear cholesteatoma.

Labyrinthine fistula is a complication of chronic otitis media with cholesteatoma. Canal wall down tympanoplasty with partial mastoid cavity obliteration and complete removal of cholesteatoma matrix was adopted in five cases of labyrinthine fistula. The operation resulted in elimination of vertigo. Sensory hearing has been saved in two cases. Air conduction hearing improved in one case. In three cases whose air conduction deteriorated post-operatively, bone conduction worsened in two cases and remained unchanged in one case (Tympanoplasty type 0 was performed in the other one case.) During the follow-up period, otorrhea improved in all cases and there was no evidence of recurrence of cholesteatoma. If the hearing of the other ear is acceptable, we suggest one-stage canal wall down tympanoplasty with complete removal of cholesteatoma matrix and partial mastoid cavity obliteration. It provides low recurrence rate of cholesteatoma and there is no need of re-operation.

Mastoid Osteoplasty—A study of twenty cases

A study of mastoid cavity obliteration by autogenous bone pate (Mastoid Osteoplasty) was carried out on 20 cases of chronic suppurative otitis media of atticoantral type. After thorough eradication of cholesteatoma autogenous bone pate (uninfected) was used alongwith tragal cartilage for obliteration of mastoid cavity and reconstruction of the posteorosuperior meatal wall. 10 (50%) cases resulted in dry stable ear at the end of six months. Relevant literature on the subject has been reviewed and long term follow up is recommended.

RECONSTRUCTION OF DISCHARGING MASTOID CAVITIES USING THE TEMPORALIS MYOFASCIAL FLAP

Muscle obliteration of the troublesome mastoid cavity is one method of achieving a permanently dry ear, although long-term results are often disappointing. An operation is described, which is a modification of existing techniques and utilizes a temporalis myofascial flap. This procedure has been used on 46 discharging mastoid cavities and produced encouraging results. It provides a simple, safe and reliable solution to the problem.

Ionomer-based bone substitute in otologic surgery.

During post-set hardening the self-curing bone substitute Ionocem develops a solid bond with the adjacent bony tissue, leaving no empty spaces. The fully matured material can be fixed to bone with freshly mixed cement or it may be used as a blank, e.g. an ossicular implant (Ionos ossicle). After insertion of 945 alloplastic middle ear prostheses over a period of 4.5 years, the take-rate was 94%. In some patients revision surgery became necessary, in 50% of cases because of prosthesis dislocation. A granular version of the cement (Ionogran) was implanted in 46 ears for obliteration of mastoid cavities and showed complete mucosal overgrowth within a maximal period of 3 months. Posterior canal wall reconstruction with the self-curing bone substitute was done in 74 patients, with revisions required in 12 cases because of persistent epithelial deficits in the external ear canal or epitympanic retraction. Overall results showed that the ionomer-based cement was a useful substitute for bone in reconstructive otologic surgery.

外耳道削除後の乳突腔に発生する諸問題

Mastoid cavity problems were studied in 113 ears that had the posterior canal wall removed during surgery (open tympanoplasty, radical mastoidectomy, modified radical mastoidectomy) for middle ear cholesteatoma. Posterior canal wall reconstruction with mastoid obliteration was performed in 19 ears, mastoid obliteration only in 10 ears, and no treatment for the open mastoid cavity in 84 ears.The total incidence of mastoid cavity problems was 30.1%. Aural discharge was most frequently observed (24.8%). Other problems included postoperative development of mastoid air cells, cholesteatoma or cyst formation, the absorption of the reconstructed canal wall, and mycosis. Cavity problems were more frequently observed in the groups with reconstruction or obliteration because of the absorption of those materials. Patients under 9 years old frequently had cavity problems, and additional surgery was performed in 44.1%.Preservation of the canal wall is most important in preventing the cavity problems, and firm obliteration of the open mastoid cavity with bone tissue or ceramics is necessary in patients that have the canal wall removed.

乳突腔充填術の長期経過観察

乳突腔充填術の長期経過観察

Surgical management of the discharging mastoid cavity

Abstract A survey of 67 patients with 74 mastoid cavities has been carried out. During the study period they made a total of 126 cavity/outpatient visits. Thirty-five patients (56 per cent) had discharge from at least one cavity on at least one outpatient visit. At only 5 per cent of visits was the discharge classified as profuse. A retrospective study of 54 mastoid revision operations on 51 patients has been made. Overall 59 per cent of operations resulted in a dry ear. The best results were achieved by carrying out cavity revision combined with a meatoplasty (83 per cent dry ears). Cavity revision alone produced a dry ear in only 57 per cent of cases. The worst results were produced by soft tissue obliteration (33 per cent dry ears). This supplement also presents the early results of a prospective investigation of bone pate obliteration of mastoid cavities. Of the eight cases studied so far, five (63 per cent) have dry ears following surgery. Three of the patients in this group had undergone previous unsuccessful revision surgery using other techniques. Cavity revision with meatoplasty is the technique of choice for most patients, but mastoid obliteration offers potential advantages for younger patients, particularly those wishing to swim.

Permanent obliteration of old radical mastoid cavities combined with tympanoplasty.

An open radical mastoid cavity presents a handicap to the patient. If elimination of the cavity appears desirable, one should use an operative technique which does not incur the risk of a cholesteatoma redeveloping. In our experience obliteration of the cavity with non-resorbable methacrylate Sulfix-6 is the best way to achieve this. The arguments in favour of this view are presented and the operative technique is described.

The Meatally Based Musculoperiosteal Flap in Cavity Obliteration

A meatally based musculoperiosteal flap that was formed for radical mastoid cavity obliteration was deliberately excised during revision surgery in three cases of recurring tympanic cholesteatoma. The flaps, which contained subcutaneous connective tissue, were well vascularized and contained large, viable muscle bundles and many nerve trunks from the postauricular branch of the facial nerve. In two cases, the periosteum-attached bone chips that had been removed from the patient's mastoid tip region and implanted to form a new bony canal wall were viable and gave the intended support for the meatus after radical ear surgery.

Mastoid and middle ear cavity obliteration for control of otitis media.

Total soft tissue obliteration of the mastoid-middle ear cavity and primary closure of the external auditory meatus were employed in six patients to control chronic suppurative otitis media. Previously, all these patients had unsuccessful surgery and all but one had profound loss of cochlear function. Thorough removal of cholesteatoma, granulation tissue, and ear canal skin is necessary before total obliteration can be performed safely. Wound healing was complete by one to two weeks postoperatively and all patients have been asymptomatic for two to seven years.

An experimental study of obliteration of mastoid cavity by musculoplasty

In order to compare and evaluate the early histobathological changes in the pedicle and free muscle grafts used for mastoid cavity obliteration, 10 healthy squirrel monkeys were selected, five of them were grafted with free muscle grafts and the rest with pedicle muscle grafts, after creating a mastoid cavity. These animales were perfused after a time interval of 15 days, one month, two months, three months and six months. The temporal bones of these monkeys were acquired, processed and studied for histopathological changes.

Soft tissue technique in musculoplasty obliteration of mastoidectomy cavities.

AbstractWhen properly performed musculoplasty is capable of producing a satisfactory canal reproduction and a high percentage of postoperative trouble free ears. Failure to obtain mastoid cavity obliteration with this procedure is due to improper preparation and placement of the soft tissue pedicles and does not represent a deficiency in the operation itself.A method of musculoplasty which evolved during the performance of 346 cases of this type of operation during the past 11 years is described in detail. The method is based upon the principles of an adequate incision; utilization of all available adjacent soft tissue for obliteration; sufficient mobility of the pedicle flaps to insure cavity adaptation; beveling of the cavity margins; “overfilling” of the mastoid defect; and, finally, fixation of the obliterative pedicles by suturing.Using this technique, the following results have been obtained: Eighty‐one percent trouble‐free postoperative cavities with a satisfactory canal reproduction rate of 68 percent. (Five or more years observation on 100 cases.) Where combined with tympanoplasty, utilizing a malleostapediopexy conductive repair, closure of the air‐bone gap to within 15 db was maintained in 65 percent of the cases. (Two or more years observation on 40 cases.) Postoperative occurrence of cholesteatoma has been limited to 2 percent residual and 1 percent recurrent. (Five or more years observation on 100 cases.)

Complications following obliterative mastoid operations.

The types of obliterative operations which I am going to talk about are listed below: Lining of mastoid cavity with a thick pedicled skin flap containing subcutaneous tissue; Lining of mastoid cavity with vein homografts; Filling in of mastoid cavity (and tympanum) with muscle and fascia, musculoplasty or myoplasty; Obliteration of mastoid cavity with autogenous bone grafts and lining the surface with skin. The method of filling in of the mastoid cavity and sometimes the tympanum as well with muscle or muscle and fascis are now techniques, giving very good immediate results. Some form of myoplasty or musculoplasty, as it is sometimes known, is probably the most commonly performed of all the obliterative mastoid operations. I have tried to discover the complications in the immediate and the long-term, both by a study of the published work on this method and also from my own experience and

Radical mastoidectomy with cavity obliteration.

OBLITERATION of the radical mastoid cavity which has been adopted again extensively was already known to Mosher 1 who, in 1911, made successful occlusions of the cavity utilizing a superiorly pedicled musculoperiosteal flap from the posterior wound margin of the postauricular incision. Later, Popper 2 used a similar principle but with the flap pedicled anteriorly and attached at the posterior ear canal wall. We have employed the anteriorly pedicled musculoperiosteal flap routinely since 1961 in surgery for chronic ear disease. 3 In addition, simultaneous reconstruction of the drum has been made with a fascial free graft which, together with the meatal skin and the muscle flap, has made up the posterior meatal wall. It is the purpose of the present study, besides recording changes in hearing, to obtain information as to the appearance of the ear canal after obliteration of the cavity and to find whether the cholesteatoma has recurred

Obliteration of mastoid cavities by musculoplasty

Obliteration of mastoid cavities by musculoplasty

Obliteration of Mastoid Cavities in Temporal Bone Surgery

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OBLITERATION OF MASTOID CAVITIES IN TEMPORAL BONE SURGERY. EIGHTY CASES OPERATED ON ACCORDING TO THE METHOD OF GUILFORD.

OBLITERATION OF MASTOID CAVITIES IN TEMPORAL BONE SURGERY. EIGHTY CASES OPERATED ON ACCORDING TO THE METHOD OF GUILFORD.

Mastoid osteoplasty. Obliteration of mastoid cavity using autogenous cancellous bone: final progress report.

Mastoid osteoplasty. Obliteration of mastoid cavity using autogenous cancellous bone: final progress report.

Otitis Media and Complications: Summaries of the Bibliographic Material Available for 1960

<h3>Chronic Otitis Media and Mastoiditis</h3> Palva and Pulkkinen²(Turku, Finland) reported the hearing level obtained in 190 ears after atticoantrotomy. The series ran from 1954 to 1958 inclusive. In 91 cases a columella effect, Wullstein type 3, was aimed at by removing the incus and head of the malleus allowing the drum to adhere to the head of the stapes. The cases requiring only simple atticoantrotomy reached a serviceable hearing level, a 30 db. average for conversational tones, in 72% of the 99 cases. The cases done by the columella technique reached the serviceable level in 40% of the 91 cases. Rambo³(New York) again outlined his method for obliteration of the large radical mastoid cavity by the use of temporal muscle flaps. He now uses a 2-stage procedure when he plans to do a later fenestration. He forms a mucosa-lined air space in the region of the