Canal wall down mastoidectomy with obliteration versus canal wall up mastoidectomy in primary cholesteatoma surgery

Wilkie, Mark D.; Chudek, Dorota; Webb, Christopher; Panarese, Alessandro; Banhegyi, Gyorgy

doi:10.1017/s0022215119002408

Cited by 20 publications

(29 citation statements)

References 23 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To date, all patients managed with mastoid obliteration (either via CWD or ICW mastoidectomy) have avoided further recurrence. Other reports in the literature have advocated the value of mastoid obliteration for management of recurrent cholesteatoma 14‐18 . Our work supports this approach for patients with refractory disease and failed attempts to preserve the canal wall, while demonstrating composite alloplastic reconstruction as an effective means of repairing EAC defects in cases where the surgeon or patient prefers to maintain the EAC.…”

Section: Discussionsupporting

confidence: 74%

“…The material used in this study (5 g,Mimix) costs $663 at our institution, although an equivalent smaller-volume preparation (2 g, OtoMimix-Olympus America, Southborough, of recurrent cholesteatoma. [14][15][16][17][18] Our work supports this approach for patients with refractory disease and failed attempts to preserve the canal wall, while demonstrating composite alloplastic reconstruction as an effective means of repairing EAC defects in cases where the surgeon or patient prefers to maintain the EAC. Furthermore, the equivalent cholesteatoma recurrence rates between groups suggest that factors besides the nature of EAC repair ultimately contribute to cholesteatoma recurrence.…”

Section: Discussionsupporting

confidence: 59%

See 1 more Smart Citation

Outcomes of a novel alloplastic technique for external auditory canal repair in tympanomastoidectomy

LeClair

Bessen

Rees

et al. 2020

Laryngoscope Investig Oto

View full text Add to dashboard Cite

Objective To analyze surgical outcomes of a novel alloplastic reconstruction technique for partial external auditory canal (EAC) defects in tympanomastoidectomy. Methods Retrospective study of 51 patients with cholesteatoma who underwent repair of partial EAC defects during tympanomastoidectomy at a tertiary referral center over 8 years. Nineteen patients were treated with a novel alloplastic graft technique using hydroxyapatite cement and bone pâté for EAC repair. Thirty‐two patients treated with traditional cartilage repair of the EAC served as a control group. The primary outcomes measured were postoperative cholesteatoma recurrence rates, infection rates, and mean air‐bone gap (ABG). Results Twenty of the 51 cases (39.2%) were revision surgeries for cholesteatoma recidivism, with a greater proportion of revision surgeries in the alloplastic group (57.9% vs 28.1%, P = .04). There was no significant difference in postoperative cholesteatoma recurrence (P = 1.00) or infection rates (P = .64) between the two techniques, with the alloplastic group experiencing slightly lower rates of recurrence (36.8%) and infection (5.3%) than cartilage repair (37.5% recurrence, 12.5% infection). Mean postoperative ABGs were comparable between the alloplastic (21.5 dB) and cartilage group (26.0 dB, P = .10). Conclusions Composite alloplastic and bone pâté reconstruction is an effective technique to repair partial EAC defects in tympanomastoidectomy, with comparable postoperative hearing outcomes and no increased risk of cholesteatoma recurrence or infection compared to traditional cartilage repair. Recidivism rates were relatively high in both groups, likely due to the high rate of revision surgeries and aggressive nature of cholesteatoma within the cohort. Level of Evidence Level 3B.

show abstract

Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 59%

Outcomes of a novel alloplastic technique for external auditory canal repair in tympanomastoidectomy

LeClair

Bessen

Rees

et al. 2020

Laryngoscope Investig Oto

View full text Add to dashboard Cite

show abstract

“…Eradication of cholesteatoma, prevention of recurrence, and restoration of hearing are the ideal goals of mastoid surgery. However, the main two surgical procedure canal walls up and down mastoidectomy cannot achieve these goals [3,[16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

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

Shewel

Abougabal

2020

Egypt J Otolaryngol

View full text Add to dashboard Cite

Background: 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. Results: This 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. Conclusions: Retrograde 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.

show abstract

“…The chronic postoperative temporal bone cavity inflammation (CPTBCI) typically implies a chronically discharging radical mastoid cavity, which results from canal wall down (i.e., radical) mastoidectomy ( Gluth et al, 2013 ). This otological surgical procedure is performed in about 53% of cholesteatoma surgery ( Wilkie et al, 2019 ). Although the CPTBCI affects only 1.5% of patients with the radical mastoid cavity ( Pareschi et al, 2019 ), its burden on quality of life and healthcare is significant ( Khalil and Windle-Taylor, 2003 ; Dornhoffer et al, 2008 ).…”

Section: Introductionmentioning

confidence: 99%

Autologous Platelet- and Extracellular Vesicle-Rich Plasma Is an Effective Treatment Modality for Chronic Postoperative Temporal Bone Cavity Inflammation: Randomized Controlled Clinical Trial

Vozel

Božič

Jeran

et al. 2021

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

PurposeTo determine the efficacy of autologous platelet- and extracellular vesicle-rich plasma (PVRP) to treat chronic postoperative temporal bone cavity inflammation (CPTBCI) after exhausting surgical and standard conservative therapies.Materials and MethodsPatients were randomly allocated to treatment with PVRP (PVRP group) or standard conservative methods (control group) in a setting of four once-monthly checkups and subsequent follow-up. The treatment outcome was measured with the Chronic Otitis Media Questionnaire-12 (COMQ-12), CPTBCI focus surface area, and CPTBCI symptom-free time after the fourth checkup.ResultsEleven patients from each group completed the trial; 95% of patients suffered from chronically discharging mastoid cavity (the type of CPTBCI). Within four checkups, the COMQ-12 score decreased statistically significantly in the PVRP group (p < 0.001) but not in the control group (p = 0.339). The CPTBCI foci surface area decreased statistically significantly between the first and second checkups (p < 0.0005) but not between other checkups (p > 0.05) in the PVRP group. No statistically significant differences in CPTBCI foci surface area were detected between checkups in the control group (p = 0.152). Nine patients from the PVRP group and three patients from the control group were CPTBCI symptom-free at the fourth checkup. The median symptom-free time was 9.2 months (95% CI [7.4, 11.9]) in the PVRP group. Cumulatively, 49% of patients in the PVRP group remained CPTBCI symptom-free for 12.7 months after the fourth checkup.ConclusionAutologous PVRP represents a novel additional and successful treatment modality for a chronically discharging radical mastoid cavity when the surgical and standard conservative treatment methods have been exhausted.Trial Numberhttps://clinicaltrials.gov (NCT04281901).

show abstract

Canal wall down mastoidectomy with obliteration versus canal wall up mastoidectomy in primary cholesteatoma surgery

Cited by 20 publications

References 23 publications

Outcomes of a novel alloplastic technique for external auditory canal repair in tympanomastoidectomy

Outcomes of a novel alloplastic technique for external auditory canal repair in tympanomastoidectomy

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

Autologous Platelet- and Extracellular Vesicle-Rich Plasma Is an Effective Treatment Modality for Chronic Postoperative Temporal Bone Cavity Inflammation: Randomized Controlled Clinical Trial

Contact Info

Product

Resources

About