Long-term follow-up results of canal wall down tympanoplasty with mastoid obliteration using the bone pate plate for canal wall reconstruction in cholesteatoma surgery

摘要

BACKGROUND: The pathogenesis of recurrent cholesteatoma can be roughly divided into residual lesions and re-retraction of the epithelium. To prevent both residual and re-retraction cholesteatoma, we performed canal wall down tympanoplasty with mastoid obliteration using the bone pate plate for canal wall reconstruction as a fundamental surgical treatment for patients with acquired cholesteatoma. We attempted to achieve the complete extirpation of cholesteatoma in the wide surgical field made by the canal wall down procedure and simultaneously prevent recurrent retraction cholesteatoma and regain the physiologic canal wall, in which patients can have a "maintenance-free ear." OBJECTIVE: The surgical method used in the present study was described, and the long-term postoperative results of this method were evaluated. STUDY DESIGN: Retrospective study. PATIENTS: Participants were 118 patients with acquired cholesteatoma who underwent canal wall down tympanoplasty with mastoid obliteration and could be followed-up for more than 5 years. MAIN OUTCOME MEASURES: Postoperative changes in the reconstructed canal wall, the rate of otorrhea, and exposure of the material were examined using endoscopic images, medical charts, and CT scans. RESULTS: A total of 113 ears (95.8 %) achieved the nearly physiologic appearance of the external auditory canal, and these conditions were maintained throughout the follow-up periods. However, recurrent cholesteatoma was not observed during the follow-up periods. Postoperative otorrhea was observed in 2.5% of ears. Exposure of the bone pate was only noted in 1 patient (0.8 %). Postoperative CT scans confirmed that ossification developed in the bone pate used in the reconstructed canal wall and mastoid surface. CONCLUSION: Canal wall down tympanoplasty with mastoid obliteration using the bone pate plate for canal wall reconstruction prevents both recurrent and residual cholesteatoma and contributes to a good quality of life for the patient.