Surgical Results of Retrograde Mastoidectomy with Primary Reconstruction of the Ear Canal and Mastoid Cavity

Figure 1

Schematic representation of the surgical procedure for mastoid exclusion. (a) Bone chips and paté are harvested with chisels and drill from the healthy mastoid cortex at the beginning of the mastoidectomy. (b) A retrograde mastoidectomy is performed to remove the cholesteatoma. Dotted lines indicate areas for further exposure to be achieved as needed. (c) The ear canal wall is reconstructed with several pieces of curved bony plates placed on the preserved canal wall and tegmen tympani. The isolated mastoid cavity is filled with bone chips. (d) Several pieces of bone chips are placed medially on the attic wall to obliterate the protympanum while the malleus head is removed. (e) Superiorly based temporalis muscle fascia is rotated to cover the underlying bone chips. (f, g) An areolar tissue graft overlaps the rotated fascia and is positioned under the eardrum remnant using the underlay technique. (h) Coronal view.