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Obliteration of Radical Cavities and Total Reconstruction Procedure Without Staging After Canal Wall Down Mastoidectomy: Long-term Results.

Liu SC, Wang CH, Huang BR - Clin Exp Otorhinolaryngol (2015)

Bottom Line: Recurrent cholesteatoma was found on postoperative follow-up in two of the revision patients (7.4%) but none in the primary patients.Over 86.4% of all cases were water resistant.We believe that our technique could be a convenient method in disease control and providing an excellent basis for hearing restoration simultaneously.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

ABSTRACT

Objectives: We evaluate the long-term surgical and hearing results using a canal wall down mastoidectomy technique followed by cavities obliteration, canal wall reconstruction and ossiculoplasty without staging.

Methods: A total of 44 patients between January 2002 and October 2009 were selected and 27 of them were revision cases. Preoperative and postoperative pure tone average (PTA) and air-bone gap (ABG) were assessed and compared 1 and 4 years after surgery.

Results: The middle ear was well healed and aerated in 40 patients (90.9%) and the tympanic membrane was intact in 42 patients (95.5%). Recurrent cholesteatoma was found on postoperative follow-up in two of the revision patients (7.4%) but none in the primary patients. Seven patients were found to have partial canal bone absorption, but revision surgery was not required. Over 86.4% of all cases were water resistant. Long-lasting improvement and/or preservation of hearing, with maintenance of PTA-ABG closure in 63.7% of all cases within 20 dB, were obtained.

Conclusion: The efficacy of our technique after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method in disease control and providing an excellent basis for hearing restoration simultaneously.

No MeSH data available.


Related in: MedlinePlus

Schematic figures of operating technique. (A) The posterior bone canal wall is reconstructed with the bone-connective tissue composite graft (white arrow). (B) The cavities are obliterated with bone chips and pâté, using the parallel overlapping stacking method. (C) The superiorly meatal pedicle flap (white bifid tail arrow) is shielded the surface of the obliterated cavity. (D) The ossicle chain and eardrum is reconstructed without staging (black arrow, inferiorly based conchal bowl flap; black bifid tail arrow, tympanomeatal flap; black arrowheads, split-thickness skin grafts).
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Figure 2: Schematic figures of operating technique. (A) The posterior bone canal wall is reconstructed with the bone-connective tissue composite graft (white arrow). (B) The cavities are obliterated with bone chips and pâté, using the parallel overlapping stacking method. (C) The superiorly meatal pedicle flap (white bifid tail arrow) is shielded the surface of the obliterated cavity. (D) The ossicle chain and eardrum is reconstructed without staging (black arrow, inferiorly based conchal bowl flap; black bifid tail arrow, tympanomeatal flap; black arrowheads, split-thickness skin grafts).

Mentions: Reconstruction starts by reconstructing the posterior bone canal wall with a free bone-connective tissue composite graft. To keep it firmly in the desired position, we packed an ear mold inside the external ear canal made from wet cotton (Fig. 2A), which was shaped to closely mimic the normal anatomic dimensions. Next we completely fill the mastoid cavity and the entire attic region with bone chips and pâté, using the method we called "parallel overlapping stacking method" (Fig. 2B). The superiorly meatal pedicle flap was used to shield the anterior surface of the free bone-connective tissue composite graft (Fig. 2C). The ossicle chain was reconstructed with autologous incus or autologous bone fragment in one stage. The tympanic membrane was then reconstructed by temporalis fascia graft (Fig. 2D). In cases with obvious canal skin loss during CWD procedure, the split-thickness skin graft is used to enhance the canal epithelization. The final step of reconstruction is to insert gelfoam in the middle and external ear canal to keep the temporalis fascia graft and ossicle prosthesis in place. External auditory meatoplasty was performed to prevent postoperative stenosis of meatal orifice by using Wolfensberger's Inferiorly based conchal bowl flap (Fig. 1A) [5]. This flap also was used to overlap most of the superiorly meatal pedicle flap (Fig. 2D) and was fixed in place with Sofra-tulle dressing (Hoechst Marion Roussel, Zürich, Switzerland).


Obliteration of Radical Cavities and Total Reconstruction Procedure Without Staging After Canal Wall Down Mastoidectomy: Long-term Results.

Liu SC, Wang CH, Huang BR - Clin Exp Otorhinolaryngol (2015)

Schematic figures of operating technique. (A) The posterior bone canal wall is reconstructed with the bone-connective tissue composite graft (white arrow). (B) The cavities are obliterated with bone chips and pâté, using the parallel overlapping stacking method. (C) The superiorly meatal pedicle flap (white bifid tail arrow) is shielded the surface of the obliterated cavity. (D) The ossicle chain and eardrum is reconstructed without staging (black arrow, inferiorly based conchal bowl flap; black bifid tail arrow, tympanomeatal flap; black arrowheads, split-thickness skin grafts).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553353&req=5

Figure 2: Schematic figures of operating technique. (A) The posterior bone canal wall is reconstructed with the bone-connective tissue composite graft (white arrow). (B) The cavities are obliterated with bone chips and pâté, using the parallel overlapping stacking method. (C) The superiorly meatal pedicle flap (white bifid tail arrow) is shielded the surface of the obliterated cavity. (D) The ossicle chain and eardrum is reconstructed without staging (black arrow, inferiorly based conchal bowl flap; black bifid tail arrow, tympanomeatal flap; black arrowheads, split-thickness skin grafts).
Mentions: Reconstruction starts by reconstructing the posterior bone canal wall with a free bone-connective tissue composite graft. To keep it firmly in the desired position, we packed an ear mold inside the external ear canal made from wet cotton (Fig. 2A), which was shaped to closely mimic the normal anatomic dimensions. Next we completely fill the mastoid cavity and the entire attic region with bone chips and pâté, using the method we called "parallel overlapping stacking method" (Fig. 2B). The superiorly meatal pedicle flap was used to shield the anterior surface of the free bone-connective tissue composite graft (Fig. 2C). The ossicle chain was reconstructed with autologous incus or autologous bone fragment in one stage. The tympanic membrane was then reconstructed by temporalis fascia graft (Fig. 2D). In cases with obvious canal skin loss during CWD procedure, the split-thickness skin graft is used to enhance the canal epithelization. The final step of reconstruction is to insert gelfoam in the middle and external ear canal to keep the temporalis fascia graft and ossicle prosthesis in place. External auditory meatoplasty was performed to prevent postoperative stenosis of meatal orifice by using Wolfensberger's Inferiorly based conchal bowl flap (Fig. 1A) [5]. This flap also was used to overlap most of the superiorly meatal pedicle flap (Fig. 2D) and was fixed in place with Sofra-tulle dressing (Hoechst Marion Roussel, Zürich, Switzerland).

Bottom Line: Recurrent cholesteatoma was found on postoperative follow-up in two of the revision patients (7.4%) but none in the primary patients.Over 86.4% of all cases were water resistant.We believe that our technique could be a convenient method in disease control and providing an excellent basis for hearing restoration simultaneously.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

ABSTRACT

Objectives: We evaluate the long-term surgical and hearing results using a canal wall down mastoidectomy technique followed by cavities obliteration, canal wall reconstruction and ossiculoplasty without staging.

Methods: A total of 44 patients between January 2002 and October 2009 were selected and 27 of them were revision cases. Preoperative and postoperative pure tone average (PTA) and air-bone gap (ABG) were assessed and compared 1 and 4 years after surgery.

Results: The middle ear was well healed and aerated in 40 patients (90.9%) and the tympanic membrane was intact in 42 patients (95.5%). Recurrent cholesteatoma was found on postoperative follow-up in two of the revision patients (7.4%) but none in the primary patients. Seven patients were found to have partial canal bone absorption, but revision surgery was not required. Over 86.4% of all cases were water resistant. Long-lasting improvement and/or preservation of hearing, with maintenance of PTA-ABG closure in 63.7% of all cases within 20 dB, were obtained.

Conclusion: The efficacy of our technique after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method in disease control and providing an excellent basis for hearing restoration simultaneously.

No MeSH data available.


Related in: MedlinePlus