Obliteration reduces the volume of the mastoid cavity ( 2, 9), thereby reducing the meatal size needed for effective clinic management.
Mastoid obliteration has been proposed to facilitate healing and epithelialization ( 8, 9), and can be performed at the original canal-wall-down procedure or in a delayed secondary procedure after the canal wall is taken down ( 9). Obliteration can be performed using a variety of techniques or materials, including but not limited to autologous bone chips and dust ( 10), hydoroxyapetite ( 11, 12), cartilage ( 13), and periosteal-pericranial flaps ( 8). Mastoid obliteration has gained increasing attention as an adjunct to open mastoid procedures ( 2, 9). These concerns have led some to primarily advocate for the use of canal-wall-up mastoidectomies ( 4), or propose the reconstruction of the ear canal-mastoid partition ( 6) or obliteration of the mastoid cavity ( 2, 7- 9). Open mastoid procedures have been criticized for the unfavorable cosmetic appearance of a large meatoplasty, the perpetual need for intermittent cleaning, as well as the propensity for chronic moisture and intermittent super-infection or drainage ( 2, 5). Despite careful observation of best practices including mastoid saucerization, removal of the mastoid tip, lowering of the facial ridge, and creation of an adequately sized meatus ( 4), moisture may persist in areas of the mastoid bowl leading to stasis of mucoid exudates, localized areas of infection, and underlying mucosal changes.
Persistent moisture, infection, and drainage is problematic in as many as one-third of patients requiring revision surgery following canal-wall-down mastoidectomy ( 3), which may be attributed to mucosalized surfaces, persistent cell tracts, or poorly ventilated areas opening into the mastoid bowl ( 2). Exteriorization of attic and mastoid disease with a canal-wall-down mastoidectomy has a high rate of success in achieving a safe ear ( 1), but there is a need for continuous care including a high incidence of moisture resulting in drainage or crusting ( 3). The primary goal of surgical intervention for chronic ear disease is the development of a safe, dry, and low-maintenance ear ( 1, 2).
0 kommentar(er)
