Mastoid Obliteration with Bone Paste and Fat

Lee, Won Sang; Choi, Jae Young; Yang, Hae Dong; Cho, Chang Hyun; Kim, In Sup

Abstract

BACKGROUND AND OBJECTIVES: Mastoidectomy with canal wall-up technique provides more healthy skin lining conditions of the external ear canal than mastoidectomy with canal wall-down techniques which have several disadvantages. However, in patients who have erosive scutum or posterior wall defects, the canal-wall down procedure is selected for preventing retraction pocket and recurrence of cholesteatoma. We have attempted a new surgical procedure to avoid disadvantages of the canal wall-down procedure in patients with scutum or posterior wall defects.
MATERIALS AND METHODS
In 84 patients with chronic otitis media whose scutum or posterior walls have defects, we advocated a new surgical procedure. The posterior wall was kept up, the defected scutum and/or posterior wall was reconstructed with cortical bone paste, and the mastoid cavity was obliterated with abdominal fat. Staged ossiculoplasty was performed for 11 patients.
RESULTS
Removal of the bone paste was necessary for only one patient due to infection, but none of the patents had absorption of reconstructed posterior canal wall. In most patients, the wound completely healed within 3 weeks. The mean hearing gain was 21 dB after the staged ossiculoplasty.
CONCLUSION
With this procedure, we could avoid disadvantages of the canal wall-down procedure. And in staged ossiculoplasty we found enough middle ear space for ossicle reconstruction.