The Effect of Mastoid Obliteration Technique Using Superiorly Based Musculoperiosteal Flap and Autologous Conchal Cartilage / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The debate regarding the surgical technique for the management of open mastoid cavity still continues. In this study, we investigated the mastoid obliteration effect of superiorly based musculoperiosteal flap (SBF) with or without the combination of autologous conchal cartilage comparing with the well known Palva flap. MATERIAL AND METHOD: The 51 ears of 51 chronic otitis media or cholesteatoma patients who had been performed open cavity tympanomastoidectomy surgery with mastoid obliteration during the period from 1998 to 1999 were included in this study. Of the 51 ears, mastoid obliteration was performed using SBF and conchal cartilage in 25 ears, using SBF only in 18 ears and using the Palva flap in 8 ears. The duration of cavity epithelization and the increment of ear canal volume were compared among these three groups. The volume of ear canals and postoperative cavities were measured by filling the ear canals with sterile saline solution up to the cartilaginous part of the ear canal, starting at the level of tympanic membrane when the patient was lying on his side with the ear examined facing upward. RESULTS: Analysis of the data showed significant differences among the three groups in either duration of cavity epithelization (SBF & cartilage: 76+/-20 days, SBF only : 85+/-18 days and Palva flap : 106+/-21 days) and increased rate of postoperative ear canal volume (SBF & cartilage : 72%, SBF : 102% and Palva flap : 171%). CONCLUSION: The results of this study shows better outcomes in the groups of SBF & cartilge or SBF only compared with the group of Palva flap in terms of duration of cavity epithelization and increment of ear canal volume. Especially, SBF combined with autologous conchal cartilage achieves more favorable results. Thus, we suggest that the SBF & cartilage mastoid obliteration technique is one of the useful technique for the patients with open cavity tympanomastoidectomy.

Partial Mastoid Obliteration Using Inferior Based Musculoperiosteal Flap and Autogenous Conchal Cartilage Chips / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, canal down mastoidectomy tends to be more frequently selected for complete eradication of the lesion and prevention of recurrence. Therefore, the problems attendant to the open mastoid continue to be of concern. Although various techniques have been used to solve the cavity problems, no single procedure has yet been devised that entirely accomplished this purpose. We evaluated the effects of partial mastoid obliteration using inferior based musculoperiosteal flap and autogenous conchal cartilage chips. MATERIALS AND METHODS: Twenty four cases were performed with mastoid obliteration using inferior based musculoperiosteal flap and autogenous conchal cartilage chips obtained from meatoplasty. There were 11 cases for control which were performed with canal down mastoidectomy without obliteration. We compared these two groups in the duration of epithelialization, accumulation of debris, presence or absence of drainage, shape of remodeled canal and caloric response and evaluated survival or atrophy of flap and absorption of cartilage chips. RESULTS: Obliteration group showed more rapid healing and epithelialization and less accumulated epithelial debris. Atrophy of flap or absorption of cartilage was not observed. There was no draining ear but vertigo with nystagmus on caloric stimulation developed in both groups. CONCLUSION: This partial mastoid obliteration technique used easy and quick application instead of complete restoration of canal wall, and it may be also valuable in providing rapid epithelialization and reducing mastoid bowl volume with relatively round canal shape. Furthermore, epitympanic obliteration using cartilage chips may be an effective method to prevent formation of attic retraction pocket.