Results of revision mastoidectomy

Abstract

Patients were aged 32-69 years (mean 57.4). There were 22 female and 13 male patients. Revision mastoidectomies were applied to 14 previous ICW and 21 prior CWD mastoidectomies. Of the 35 patients, 24 patients had cholesteatoma and 11 of them did not. Of the patients who had revision surgery, 10 had ICW mastoidectomy and 25 had CWD mastoidectomy. After revision mastoidectomy, at 3-25 months follow-up (mean 16.7 months), 29 patients had been successfully treated; they had dry well epithelialized cavity, with no findings of persistent, recurrent discharge or granulation tissue and cholesteatoma. In 21 patients in whom revision CWD mastoidectomy was performed, causes of failure of previous ear surgery in order of frequency were recurrent or persistent cholesteatoma and narrow meatoplasty (80.9%), persistent sinodural angle air cells and close supratubal recess (71.4%), high facial ridge and inadequate canalplasty (66.7%), persistent tegmental air cells and tympanic membrane remnant (57.1%), persistent mastoid apex air cells and open eustachian orifice (52.4%). Causes of failure after our revision ICW mastoidectomy in order of frequency were persistent or recurrent cholesteatoma (78.6%), closed supratubal recess (64.3%), persistent sinodural angle air cells, inadequate canalplasty and persistent mastoid apex air cells (57.1%), persistent tegmental air cells (42.9%).

Single Stage Canal Wall Down Mastoidectomy with Reconstruction of the Canal Wall: 5 Years’ Experience in Fayoum Province, Egypt

“…Staging of the procedure is preferred by some authors [18,19] . It is used for a second-look operation of the posterior wall or ossiculoplasty.…”

Surgical Anatomy of Facial Nerve for Revision Transmastoid Surgery

“…The incidence of facial nerve dehiscence among patients who underwent revision mastoid surgery for chronic otitis media was reported as 28%. 19 Intraoperative facial nerve monitoring was recommended in avoiding injuries to the nerve, especially in cases of revision surgery and congenital malformations. 20 Surgical complications secondary to the lack of consistently identifiable surgical landmarks with respect to the facial nerve represent an important drawback to both transmastoid and translabyrinthine revision surgery.…”

Study on Causes and Management of Persistent Ear Discharge After Mastoidectomy for Cholesteatoma

“…The important factors contributing to failure of primary surgery are suppuration in the mastoid cavity, may be due to residual disease in the tip, along the facial ridge, zygomatic cells, sinodural angle and cholesteatoma in regions easily overlooked during surgery such as sinus tympani, facial recess and anterior epitympanic recess. (9,13,14,15,16,17,18,19) The major sites of residual/recurrent disease contributing to discharging cavities at the time of revision mastoid surgery in our series were failure of meatoplasty and high facial ridge. The attic region which was the second most common site of residual cholesteatoma in our series, disease was found in anterior epitympanum anterior to head of malleus in patients having intact malleus and removal of malleus head was mandatory to remove the disease from this area.…”

“…Perisinus/sinodural angle and mastoid tip cells should be given special attention to adequately exteriorise the mastoid air cells. (15,20) The cholesteatoma was lying deep in sinus tympani in these cases which could only be viewed by angled telescope and removal of stapes suprastructure was necessary to eradicate the disease from this area. Thus, we agree with Ajalloueyan M et.al 7 and El-Meselaty k et.al 21 that usage of otoendoscope in cholesteatoma surgery is important as it will help to reduce the incidence of residual disease in mastoid surgery.…”

“…(22,23,24) Decreasing the size of the cavity not only is important for healing but also decreases the need for post-operative cavity care. Narrow meatus is one of the common reasons of failure in CWD mastoidectomy (12,14,15,16,18) thus an enlarged meatus is an essential integral part of the CWD procedure and failure to perform an adequate meatoplasty may fail even in the most perfectly performed CWD procedures. Adequate meatoplasty opening is necessary to provide adequate surface volume ratio for aeration, epithelial stability and good post-operative visualisation.…”