Mastoidectomy elimination: obliterate, reconstruct, or ablate?

Abstract

Objective: This study aimed to evaluate a chronology of techniques used to manage troublesome open mastoid cavities, with emphasis on the selection of the mastoidectomy elimination technique most appropriate to the case at hand.

Study design: The study design was a retrospective review of techniques used in 465 consecutive elimination cases.

Setting: The study was conducted at a single surgeon's private otologic practice.

Patients: Patients with mastoidectomy elimination who were treated from 1974-1996, including 55 patients with obliterations (cavity fill-in), 372 patients with reconstructions (canal wall repair), and 38 patients with ablations (external canal closure), requiring 823 procedures, were examined.

Main outcome measures: Clinical success and complication rates of the techniques studied were measured.

Results: Optimal outcomes (89% successful) were recorded from hydroxylapatite reconstruction cases managed with canal revascularization (middle temporal flap) and cholesteatoma prevention (staging and composite grafts).

Conclusions: Obliteration is recommended only over noncholesteatomatous sites because of the risk of residual disease and the difficulty re-exploring these cases. Ablation is effective in selected, severely damaged cases. All ablation cases remained disease-free after surgery. Reconstruction is the preferred method when hearing restoration is required. Canal wall reconstruction required modifications to avoid complications from poor tissue vitality and cholesteatoma. These are outlined and discussed below.