Posterior canal wall reposition for management of cholesteatoma: Technique and results

Publication date: Available online 20 July 2017
Source:Auris Nasus Larynx
Author(s): Mohammad Kamal Mobashir, Waleed M. Basha, Abd ElRaof Said Mohamed, Mohammed Elsayed Elmaghawry
ObjectiveThe main goal of surgery in acquired middle ear cholesteatomas is the complete eradication of the disease with an ear free of discharge. This can be performed either by open or closed techniques with their benefits and drawbacks. We present the technique of reposition of the posterior canal wall for the management of cholesteatoma cases and its results and outcome.Patients and methodsThis study included 31 patients with primary acquired middle ear cholesteatoma. The surgical technique included complete cortical mastoidectomy, wide posterior tympanotomy, dividing the bony posterior meatal wall with a micro-sagittal saw and its removal, dissection and eradication of cholesteatoma, and repositioning the canal wall segment in its anatomical site.ResultsNo significant intraoperative complication occurred. An injury to the dura occurred in one patient. Damage of the bony posterior canal wall occurred in two patients during saw cutting. Residual cholesteatoma was found in two patients. No dislocation or necrosis of the reconstructed posterior canal wall was noted and the new reconstructed external ear canal appeared to be of near normal size, shape, and contour.ConclusionThis technique provides optimal surgical exposure and access to areas that are difficult to reach by CWU approach, allows removal of the cholesteatoma without intraoperative complications, decreases the rate of residual cholesteatoma, restores near-normal anatomy of the external auditory canal, and avoids the sequelae of the open mastoid cavity. Therefore, it would be a feasible alternative to the standard CWU and CWD procedures.



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