Mastoid and Epitympanic Obliteration in Canal Wall Up Mastoidectomy for Prevention of Retraction Pocket

Abstract

Objective: To evaluate the surgical outcome in patients who have undergone mastoid and epitympanic obliteration technique. Study Design: Retrospective review. Setting: Tertiary care referral center. Patients: The study group included 151 patients with cholesteatoma who underwent mastoid and epitympanic obliteration technique. This technique was applied to cases who had a strong chance of recurrent retraction pocket and cholesteatoma formation, including those patients with an adhesive drum indicating poor eustachian tube function (n = 52) and patients with a destructive scutum (n = 68). Thirty-one patients had both an adhesive drum and a destructive scutum. Intervention: The connection between the mastoid cavity and the middle ear was blocked by obliterating the epitympanum and antrum with bone pate and the remaining mastoid cavity with abdominal fat. Main Outcome Measures: The postoperative drum state, the incidence of retraction pocket formation and cholesteatoma recurrence, the surgical complications of obliteration, and the hearing outcome. Results: In 114 of 151 patients (75.4%), the middle ear was well healed and well aerated. The retraction pocket formation or cholesteatoma recurrence did not develop in any subject. Postauricular skin depression was the most common complication of this technique (n = 31 [20.5%]). In three patients (2.0%), the bone pate used for obliteration was infected. Of the 56 cases who underwent a staged operation to regain their hearing, 37 resulted in a postoperative air-bone gap less than 20 dB hearing level. Conclusion: Mastoid and epitympanic obliteration is an effective option for preventing a retraction pocket and cholesteatoma recurrence in patients with a poorly functioning eustachian tube or a defective scutum, while preserving the same advantage of the canal wall up technique.

Canal wall reconstruction and mastoid obliteration in canal wall down tympanomastoidectomized patients

“…Grafted autogenous bone pate was reported to form new bone over time, thus maintaining its shape [13]. We have also used autogenous bone pate for epitympanic obliteration to prevent retraction pocket for years and found that it was firm and well maintained [14]. In addition, autogenous bone pate is more biocompatible than artificial materials [10] and it is not so difficult to get a sufficient amount of autogenous bone pate from the cortical bones around the mastoid bowl even in the revision case if we use it only for canal wall reconstruction, not for mastoid obliteration.…”

Clinical Results of Atticoantrotomy with Attic Reconstruction or Attic Obliteration for Patients with an Attic Cholesteatoma

“…They showed that a retraction pocket occurred in 6.3% of ears. For preventing a retraction pocket and recurring cholesteatoma, obliteration of mastoid cavity and epitympanum with bone pate and abdominal fat has been suggested as one of the surgical options (17). …”

Clinical Significance of β-Tricalcium Phosphate and Polyphosphate for Mastoid Cavity Obliteration during Middle Ear Surgery: Human and Animal Study

“…Synthetic materials with higher biocompatibility have been recently evaluated in animal experiments concerning orthopedic use. However, there have been few reports of the otologic clinical applicability of such materials [2,21,26]. …”

“…On the other hand, CWUM does not appreciably change the anatomical structure, however the recurrence rate is higher than CWDM because of the limited surgical view. In addition, a retraction pocket may develop if the Eustachian tube function is insufficient in CWUM [1,2]. To compensate for these disadvantages of CWDM, reconstruction of the posterior wall of the external auditory canal (EAC) and mastoid obliteration have been attempted, especially when the mastoid cavity volume is too large to prevent a cavity problem.…”

“…To compensate for these disadvantages of CWDM, reconstruction of the posterior wall of the external auditory canal (EAC) and mastoid obliteration have been attempted, especially when the mastoid cavity volume is too large to prevent a cavity problem. In CWUM, obliterating the epitympanum and mastoid cavity is performed to prevent the retraction pockets [2,3]. …”