Modified Radical Mastoidectomy: A Relook at the Surgical Pitfalls

Abstract

The primary aim of surgery for cholesteatoma is to eliminate the disease, to produce a safe and dry ear which is self cleansing, modify the anatomy of the tympanomastoid compartment so as to prevent recurrent disease and wherever possible to reconstruct the hearing mechanism. The advances in medical technology and the medical expertise gained over a period of time have greatly influenced the results in cholesteatoma surgery. The aim of the present study was to assess the intraoperative findings during revision mastoid surgery for atticoantral disease and to ascertain the preventable factor that could reduce recurrence. A retrospective analysis of all clinical data and operative notes of patients who had undergone revision surgery for recurrent cholesteatoma, in our unit in a tertiary care centre in south India over a period of 3 years from July 2007 to July 2010 was done. 33 patients had undergone revision mastoid surgery for cholesteatoma. Most patients presented with symptoms and sign of disease about 2 years after the first surgery. The commonest complaint was recurrent foul smelling ear discharge. The most frequent site of recurrent cholesteatoma was the tip cells (72%) and the most important cause for failure of surgery with recurrence of disease was inadequate meatoplasty (70%). In our study, recurrent disease was likely due to cholesteatoma in the tip cells left uncleared and inadequate meatoplasty. Both these issues reflect faulty techniques in performing good meatoplasty or the tip cell are not adequately reduced into the external auditory canal. Bone work is generally taught well in all temporal bone workshops but no emphasis is laid on soft tissue work hence the failure and recurrence. Thus we emphasize the need to teach the budding otologists the importance of and proper technique of meatoplasty.

Clinical outcomes of revision radical mastoidectomy surgeries to dry ears: A retrospective study

“…We found that no excision of the head of the malleus intraoperatively was a major cause of residual lesions in the anterior epitympanic recess, consistent with the findings reported by Li et al [ 9 ] Prasanna Kumar et al described cholesteatoma at the sinodural angle (63%), and inadequate reduction of the posterior canal wall flush with the external auditory canal were the main concerns for recurrent or residual disease. [ 10 ] For the 19 ears (41.3%) exhibiting insufficient opening of the posterior tympanum, we removed the outer wall of the tympanic cavity and ground the facial neural crest low, which was useful in fully opening the posterior tympanum and forming a spacious surgical cavity with the external auditory canal and mastoid cavity to thoroughly remove lesions during surgery. Damage to the facial nerve should be avoided during surgery.…”