External Auditory Canal Reconstruction and Mastoid Obliteration Using Modified Palva Flap in Canal Wall Down Mastoidectomy With Tympanoplasty

Abstract

Objective: To evaluate the effectiveness of a modified Palva flap used for external auditory canal reconstruction and mastoid obliteration in canal wall down mastoidectomy. Methods: We retrospectively analyzed patients who underwent canal wall down mastoidectomy with tympanoplasty using modified Palva flap. All patients underwent pure tone audiometry and temporal bone computed tomography (CT) before surgery, and the same tests were performed in the first year after surgery. The external auditory canal volumes were calculated by summing the areas of each section selected in temporal bone CT. For each patient, the ratio of external auditory canal volume was calculated from CT taken before and after surgery. Results: The mean of external auditory canal volume after canal wall down with a modified Palva flap was about 1.4 times larger than before surgery. The modified Palva flap is effective for the reconstruction of the external auditory canal. Both pure tone audiometry level and air-bone gap showed statistically significant improvement after surgery ( Ps = .001 and .002, respectively). Conclusions: The external auditory canal volume slightly increased, but the status of mastoid obliteration was well maintained 1 year after surgery. The modified Palva flap used in this study is an easy and effective method in external auditory canal reconstruction and mastoid obliteration.

The effect of post-auricular canal wall down mastoidectomy on the position of the auricle

“…In this surgical approach, a large cavity is formed in the mastoid region. 1 Many cavity obliteration methods have been described, but these may result in complications in the mastoid cavity. 5,6 Obliteration has some other negative consequences, including delays in the detection of relapse.…”

“…Canal wall down mastoidectomy is a successful and effective technique used to eliminate inflammatory lesions, especially in cases of chronic otitis media with cholesteatoma. 1…”

“…Canal wall down mastoidectomy is a successful and effective technique used to eliminate inflammatory lesions, especially in cases of chronic otitis media with cholesteatoma. 1 This technique has several advantages, such as providing the surgeon with a good visual field, reducing relapses and being easier to follow. 2 The disadvantages of this technique are that it requires a large cavity, is associated with prolonged epithelialisation, adversely affects hearing, and requires intensive ear cleaning for the rest of the patient's life because of accumulating secretions and the crest in the cavity.…”

Materials used for mastoid obliteration and its complications: a systematic review

“…9 Residual cholesteatoma is the most frequent and serious complication. If the tissue coverage is extensive, cholesteatoma may go undetected until it becomes quite large or even results in 45 Chronic otitis media, cholesteatoma CWD Kim BG 2019 46 Chronic otitis media, cholesteatoma, adhesive otitis CWD Kim JS 2019 47 Chronic otitis media CWD Shah 2019 48 Cholesteatoma, chronic suppurative otitis media (CSOM), recurrent cholesteatoma CWD Elbary 2018 49 CSOM CWD Sorour 2018 50 CSOM CWD Lee HJ 2017 53 Chronic otitis media, cholesteatoma Canal reconstruction (previous patients had canal wall down mastoidectomies and canal wall up) Bernardeschi 2017 51 CWD (primary or revision), CWU undergoing mastoid obliteration Revision surgery following CWD Geerse 2017 52 Chronically draining mastoid cavities Revision radical cavity surgery Mestdagh 2017 54 Cholesteatoma CWD or CWU Vos 2017 55 Non-cholesteatoma chronic otitis media with chronically discharging ears despite conservative therapy CWD or CWU Cox 2016 56 Draining cavity, recurrent cholesteatoma, conductive hearing loss after mastoidectomy, glomus tumour…”