Late Results of Obliterative Cholesteatoma Surgery

Abstract

\s=b\Radical obliterative cholesteatoma surgery was performed on 463 ears. Postoperative cholesteatomas were found in 22 of 463 of the ears during the follow-up periods that ranged from five to 15 years. Eight of them were of the residual type, and 14 were of the recidive type. A substantial portion of the postoperative cholesteatomas (11 cases) was discovered as late as the sixth to the tenth postoperative years. Four of the postoperative cholesteatomas extended to the antrum or the operation cavity from the tympanic cavity or meatus, but none of them originated in the cavity area. The surgical method that was used was safe. Annual follow-up examinations for at least ten years are recommended after the obliterative radical operation for ears with cholesteatomas. (Arch Otolaryngol 1982;108:1-3) One of the primary aims of chronic ear surgery is the eradication of cholesteatoma and the prevention of its recurrence. This goal is difficult to achieve. Even today, there are differ¬ ent opinions about the methods of choice, because the other essential points in the preservation of hearing and the minimizing of postoperative treatment also must be considered.Cole,1 in 1974, further recommended (and received some support for) a modified endaural radical mastoidec¬ tomy without obliteration but com¬ pleted with tympanoplasty for treat-Turku 11, Finland (Dr Ojala). ment of ears with cholesteatoma because of the complications con¬ nected with closed methods in choles¬ teatoma surgery.The users of the intact canal wall technique25 preferred the preserva¬ tion of the posterior portion of the bony wall of the ear canal at opera¬ tion, eradicating the cholesteatoma through the meatus and operation cavity. According to the supporters of this technique, it is not always possi¬ ble to eradicate the cholesteatoma completely, even when removing the posterior portion of the bony meatal wall. Using this fact as an argument for their method, they also insist that the "second-look" operation should be done within one to two years after the primary operation, especially if an incomplete eradication of the choles¬ teatoma is suspected.One method used in cholesteatoma surgery is that of obliteration and reconstruction of the meatal wall with the Palva flap and the temporal fas¬ cia, with or without autogenous corti¬ cal bone chips, after removing the posterior portion of the bony canal wall during eradication of the choles¬ teatoma.611 Those who support the removal of the bridge regard the main disadvantages of the intact canal wall technique to be the great demand for repeated operations and the difficulty of eradicating the cholesteatoma. They believe these disadvantages could be reduced by removing the pos¬ terior portion of the bony meatal wall during the operation. The reconstruc¬ tion of the posterior portion of the meatus is not a difficult problem in connection with obliteration using a musculoperiosteal flap.8·10·11The long-term results of cholestea¬ toma surgery using the operation method developed by Palva are de¬ scribed her...

Canal wall down mastoidectomy with obliteration versus canal wall up mastoidectomy in primary cholesteatoma surgery

“…Only two previous studies have followed a similar design to that presented here, insofar as they have directly compared these two techniques. 15,16 Although both studies included a large number of cases, comparative groups were markedly unbalanced in terms of numbers: Ojala et al reported on outcomes of 463 cases, 432 of which were treated using an obliteration/reconstruction technique, 15 while Sanna et al examined outcomes for 538 cases, only 36 of which underwent obliteration/reconstruction surgery. 16 Notwithstanding, in keeping with what we have observed in the present study both studies reported more favourable disease control outcomes using obliteration/reconstruction techniques (albeit marginally so in the former study), with recidivism rates of 4.6% and 8.3% respectively for such techniques.…”

“…16 Notwithstanding, in keeping with what we have observed in the present study both studies reported more favourable disease control outcomes using obliteration/reconstruction techniques (albeit marginally so in the former study), with recidivism rates of 4.6% and 8.3% respectively for such techniques. 15,16…”

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery

“…Cholesteatoma is defined as keratinising squamous epithelium within the middle-ear cleft and mastoid 1 . The classic clinical presentation of cholesteatoma is a foul-smelling aural discharge with a pearly lesion seen on otoscopic examination.…”

“…Cholesteatoma management is usually surgical and aims to create a safe ear with no residual or recurrent cholesteatoma. Secondary aims of cholesteatoma surgery are optimising the hearing level and creating a non-discharging, self-cleaning ear 1 . Cholesteatoma surgery falls into two broad categories: closed, referring to canal wall up procedures (i.e.…”

“…A third type of surgery involves reconstruction or repair of the posterior ear canal wall or obliteration of the mastoid cavity. The various reconstruction and repair methods use cartilage, bone, fascial and muscle grafts or synthetic material 1 …”