Article
Mastoid cavity obliteration in difficult cholesteatoma cases
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Authors
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Petar Rouev
- ENT Dept., St. Ivan Rilski Hospital Stara Zagora, Stara Zagora, Bulgaria
| Published: | April 4, 2012 |
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Outline
Text
Background: The primary goal in the surgical management of chronic otitis media with cholesteatoma is the creation of a dry, safe ear. The “gold standard” for management of cholesteatoma is the canal wall down (CWD) mastoidectomy. After cholesteatoma removal if canal wall reconstruction is not possible mastoid cavity obliteration techniques can reduce the size of the cavity. The procedure is designed to prevent development of postoperative retraction pockets by obliterating the mastoid cavity and isolating the tympanum from the attic and mastoid using bone paté, cartilage etc.
Objective: To evaluate the cholesteatoma patient with mastoid cavity obliteration.
Design: Retrospective study.
Patients: 48 patients with acquired cholesteatoma of the middle ear from 144 consecutive ear operation were surgically treatment and included for follow-up from 1 to 30 months between III 2009 and IX 2011. 35 patients (age 12 to 66 years; mean 32 years, SD = 16) from this 48 cholesteatoma patients were treatment with mastoid cavity obliteration technique.
Results: Behind total cholesteatoma removal the early and late postoperative results were analyzed after the implemented reconstructive interventions including tympanoplasty I or III type and mastoid cavity obliteration. Materials for mastoid cavity obliteration are bone paté (during drilling and suctioned into a collector) or synthetic bone (b-tricalcium phosphate), cartilage (large plates or palisades) or soft tissue flaps (Palva flap).
Conclusions: Mastoid cavity obliteration cut be done after certain removal of all epithelium from the mastoid. Critical areas for mastoid cavity obliteration are anterior epitympanum, perilabyrinthine cells, retrofacial area, sinus-dura angle and tip of the mastoid.
