use of non ceramic hydroxyapatite in mastoid cavity obliteration and posterior canal wall reconstruction

ABSTRACT

Despite the higher security [concerning cholesteatoma recurrence using the open cavity procedure, yet such technique represents some disadvantages including lifelong care for the cavity, often discharging granulations, and vestibular vertigo due to the lack of labyrinthine protection. Most of these disadvantages can be avoided by mastoid cavity obliteration, which involves different materials described in literature. In this study we used non ceramic bioactive Hydroxyapatite micro granules [Osteo Graf / LD-300] with polycaboxylic acid to form a paste for mastoid cavity obliteration. In addition, we placed a conchal cartilage graft to replace the deep part of posterior canal wall, which acted as a support for the filling material and separated the middle ear cavity from the obliterated attic. Also temporal fascia grafting to repair the tympanic memberane was done. Such technique helped in a later second ossiculoplasty procedure to improve hearing in such patients. Our technique was assessed for its validity to obtain a permanent stable bony mastoid obliteration and secondary hearing gain reconstructive procedures; our assessment was clinical, radiological, and audiological. Our use of bony obliteration. The latter statement is true, as only expensive serial contrast enhanced MRI studies are needed for the detection of such recurrence when soft tissue is used for mastoid cavity obliteration