Reconstruction of the Posterior Canal Wall with Silastics in Chronic Otitis Media Surgery

Cho, Hyong Ho; Yoon, Tae Mi; Lee, Dong Hoon; Jang, Chul Ho; Cho, Yong Bum

Abstract

BACKGROUND AND OBJECTIVES
Canal wall down technique when used for treating chronic otitis media including cholesteatoma may secure better operation field and remove the lesion more easily, but may result in a problematic mastoid cavity, compared to canal wall up technique. To combine the advantages of both techniques, the concept of canal wall down technique with canal wall reconstruction has been studied. We removed the posterior bony wall for the good exposure of the pathology in the middle ear, and reconstructed the posterior wall using a silastic device called OCS (open & close technique with silastics). Alloplastic materials, cartilage, and bone have been used for the reconstruction of the wall and silicone for medical use have been proven to be safe. The purpose of this study is to report the results of a new surgical technique of canal wall reconstruction using silastics. SUBJECTS AND METHODS: Retrospective review was performed on the thirty-one patients undergoing open & close technique with silastics, OCS, from 2003 to 2005. All cases had large defect of posterior wall and scutum with cholesteatoma, and 70-80% defect of the wall was noted in 2 cases. This technique is characterized by partial canal wall down mastoidectomy for exposure and eradication of diseases, followed by immediate canal wall reconstruction using silastic sheets or C-shaped silastic devices, and supported with posterior auricular periosteal flap. RESULTS: During the average follow-up of 14 months, there was no recurrent or residual choesteatoma. Anatomic integrity of the posterior canal wall was obtained in 30 (96.8%) of 31 patients. The pinpoint perforation of posterior canal wall was observed in 4 patients and treated with temporalis fascia graft. Removal of the silastics was necessary for only one patient because of purulent otorrhea and granulation tissue formation. CONCLUSION: Canal wall reconstruction using silastics has been performed successfully without a major complication. Although long-term study in larger series of patients is required to further evaluate the efficacy of this technique, we consider this technique to be a satisfactory procedure in chronic otitis media surgery.