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Case Reports
. 2024 Oct 30:2024:4874411.
doi: 10.1155/2024/4874411. eCollection 2024.

Mastoid Obliteration With Freeze-Dried Bone Allograft in Canal Wall Down Tympanoplasty: Description of a Novel Technique and Case Report

Antonio Faita  1 , Giulia Montagner  2 , Diletta Trojan  2 , Valerio Maria Di Pasquale Fiasca  3
Affiliations
Case Reports

Mastoid Obliteration With Freeze-Dried Bone Allograft in Canal Wall Down Tympanoplasty: Description of a Novel Technique and Case Report

Antonio Faita et al. Case Rep Surg. .

Abstract

Mastoid obliteration can be performed after canal wall down (CWD) mastoidectomy with various materials. Homologous bone tissue harvested from cadaver donor represents a feasible option with advantages. The purpose of the study is to describe the case of a patient diagnosed with middle ear cholesteatoma treated with mastoidectomy of the CWD and mastoid obliteration with homologous freeze-dried corticocancellous bone particulate in the Cittadella Hospital Ear, Nose, Throat (ENT) unit. The preoperative characteristics of the patients, the procurement and processing of bone allografts, the surgical technique, and postsurgical outcomes are described. No perioperative and postoperative complications were observed, and no rejection or foreign body reactions occurred. The patient then underwent a seriated follow-up. Audiometric tests showed an improvement in hearing levels. The volume of the neoexternal ear canal was 2.01 cm3. The case demonstrated clinical stability, substantial hearing recovery, and no need for specialist cleaning of the reformed external ear canal (EEC). The freeze-dried bone tissue allograft, in the technical way we used, appears to be a viable option in mastoid obliteration because homologous bone is not affected by material shortage, has fast assimilation, and ensures a useful radiological examination scan, at a low cost.

Keywords: canal wall down mastoidectomy; cholesteatoma; freeze-dried bone; homologous bone; mastoid obliteration.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative computed tomography imaging. (A) Small posterior bone erosions compatible with resorption due to cholesteatoma. (B) Point 1, lower edge of the external auditory canal; point 2, hypointense circular signal in the mastoid compatible with cholesteatoma.
Figure 2
Figure 2
Magnetic resonance DWI sequences showing recurrence of cholesteatoma in the left ear. DWI, diffusion weighted imaging.
Figure 3
Figure 3
Steps for the preparation of the obliterative material: (A) freeze-dried corticocancellous particulate; (B) particulate is mixed with the human fibrin glue; (C) particulate and glue form a single block of material; and (D) the single block is divided into smaller pieces, which will be used for the obliteration of the mastoidectomy cavity.
Figure 4
Figure 4
Surgical steps of mastoid obliteration: (A) mastoidectomy cavity after complete drilling of the mastoid for canal wall down (CWD) mastoidectomy; (B) first reconstructive step, positioning material for myringoplasty; (C) partial mastoid obliteration; (D) complete obliteration of the mastoid cavity; (E) the obliteration is shaped to reduce the volume of the neocavity; and (F) positioning of Spongostan to sustain the myringoplasty.
Figure 5
Figure 5
Postoperative evaluation at 1 year after surgery: (A) fully re-epithelized posterior wall of the external ear canal; (B) reconstructed tympanic membrane; and (C) external aspect of the external ear canal.
See this image and copyright information in PMC

References

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