Tympanomastoid Surgery: A Technique for Repairing Posterior Osseous Canal Wall Defects with Autologous Temporalis Fascia and Bone Pâte

Abstract

A technique for repairing small to medium-sized defects in the osseous posterior superior canal resulting from pathologic or iatrogenic causes is described. Bone pâte is harvested from the mastoid cortex by means of a simple collection technique. A sandwich graft composed of autologous temporalis fascia lined with bone pâte is used to fill in the canal wall defect. This technique has been used successfully in 27 of 28 cases, with follow-up as long as 8 years. When fully healed, the bone graft has attained the texture and consistency of the normal osseous canal and, if necessary, can be curetted or drilled for reshaping during planned second-stage tympanomastoid surgery. The temporalis fascia/bone pâte graft technique is simple, easy to learn, and has proven to be a reliable method for repairing the defects described.

Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea Using Bone Pate

“…The type of bone used is of crucial importance because morselized bone pate contains an abundant mix of active osteogenic factors, osteocytes, and proteins largely absent from mature calvarial bone or cartilage, resulting in an improved quality of repair by stimulating new bone growth, the earliest signs of which are visible on the 3 month postoperative CT scan in case 1 7 . Neo‐osteogenesis secondary to bone pate reconstruction has been demonstrated in the repair of a tegmental defect 6 months after surgery 8 and separately with regard to the successful repair of posterior bony canal wall defects 9 . Although cancellous bone such as from the iliac crest has the greatest potential for neo‐osteogenesis, increased donor site morbidity renders the corticocancellous mastoid bone a more practicable option.…”

Repair of tegmen defect using cranial particulate bone graft

“…Regardless of the type of surgical approach and substance used, recurrence of the cerebrospinal fluid leak is uncommon as long as the tegmen is repaired with multiple layers of different materials [1]. One substance that has been used commonly to reconstruct holes in the tegmen is bone dust collected from a high speed burr during the initial mastoidectomy or craniotomy [2][3][4][5][6][7][8][9]. The autologous bone dust then is typically mixed with blood, and/or fibrin glue to form a paste, before it is used to fill the bony defect.…”

“…Although bone dust has been reported to be efficacious for the repair of tegmen defects, it has always been used with another substance (i.e., carbonated calcium phosphate, cartilage, duragen, fascia, muscle, split cranial bone) [2][3][4][5][6][7][8][9]. In contrast, when bone dust has been used alone to repair critical size calvarial gaps it does not ossify clinically [10][11][12] or experimentally [16][17][18].…”

“…One material that is used is bone dust collected during the electrical drilling of the cranium for access to the defect. Bone dust also is referred to as "bone paté" in the literature [2][3][4][5][6][7][8][9]. In this report we describe the use of cranial particulate bone graft to reconstruct the tegmen.…”

Canalplasty for Exostoses of the External Auditory Canal and Miscellaneous Auditory Canal Problems

“…9 This technique requires removal of bone lateral to the heads of the ossicles in the epitympanum and sculpting of the posterior surface of the bony external canal to allow placement of the fascia (Fig. 9 This technique requires removal of bone lateral to the heads of the ossicles in the epitympanum and sculpting of the posterior surface of the bony external canal to allow placement of the fascia (Fig.…”