Platelet-Rich Plasma in Reconstruction of Posterior Meatal Wall after Canal Wall Down Mastoidectomy

Abstract

Introduction Canal wall down (CWD) mastoidectomy has many drawbacks, including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). Objectives To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using titanium mesh and platelet-rich plasma (PRP) mixed with bone pate. Methods This study was conducted with 20 patients that have atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by titanium mesh and the mixture of PRP with bone pate. All patients were exposed to a full preoperative evaluation and full postoperative assessment of the complications, the appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results The PMW reconstructed by titanium mesh and the mixture of PRP with bone pate showed a smooth contour. During the follow-up of 12 to 36 months, the postoperative appearance of the external auditory canal contour was found to be smooth without hidden pouches, irregularities or stenosis in all cases. No granulation, foreign body reaction, or extrusion and/or displacement of the titanium mesh were registered. No facial palsy or recurrent cholesteatoma was reported. Conclusion The surgical reconstruction of the PMW using PRP, bone pate and titanium mesh after CWD mastoidectomy appears to be reliable without considerable complications, giving a smooth appearance to the PMW.

Materials used for mastoid obliteration and its complications: a systematic review

“…Although no complications were identified and second‐look surgery revealed a stable posterior canal wall while the deep surface of the titanium mesh was lined by mucosa, 30 Elbary et al 31 . is the only study that looked at titanium and its sample size was only 20 ears 31 …”

Mastoid Reconstruction With Platelet-Rich Plasma and Bone Pate After Canal Wall Down Mastoidectomy: A Preliminary Report

“…Blood would separate into the 3 layers: the bottom layer (red blood cells), the middle layer (PRP; platelets and white blood cells), and the top layer (platelet-poor plasma) The PRP layer was extracted just before application (Figure 1). [9][10][11] If needed, a piece of cartilage was employed for ossiculoplasty. The bone pate was applied over the walls of mastoid cavity as a carpet and then PRP plug was put comfortably in the mastoid cavity ( Figure 2).…”

“…It could increase the proliferation rate of human osteoblast-like cells and stromal stem cells; therefore, it promotes the regeneration of mineralized tissues and induces bone growth. [9][10][11][12] Accordingly, we thought it would be reasonable to use it for mastoid cavity reconstruction.…”

“…Platelet-rich plasma could promote the regeneration of mineralized tissues; however, it was not widely studied for reconstruction of mastoid cavities in the available English literature. 4,[9][10][11][12] In this work, authors present a simple and easy technique for Mastoid reconstruction (MR) (in selected group of patients) via autologous tissues: PRP and cortical bone pate.…”

“…Platelet-rich plasma could promote the regeneration of mineralized tissues; however, it was not widely studied for reconstruction of mastoid cavities in the available English literature. 4,9 -12…”