Attic reconstruction techniques in cholesteatoma surgery: a comparative analysis of cartilage versus bone pate

Abstract

Background

Cholesteatoma surgery involves canal wall down (CWD) and canal wall up (CWU) mastoidectomy. CWU is associated with higher cholesteatoma recurrence, often linked to attic retraction pockets. Attic reconstruction with cartilage or bone pate lacks comparative evidence.

Aims/Objectives

To compare the effectiveness of cartilage and bone pate in attic reconstruction during CWU mastoidectomy for cholesteatoma.

Material and Methods

We conducted a retrospective study at King Abdullah University Hospital (KAUH) in Jordan, analyzing surgeries performed from 2011 to 2021. Patients who underwent CWU mastoidectomy with attic reconstruction using tragal cartilage with perichondrium or bone pate were included.

Results

Of 48 patients analyzed, 26 had cartilage graft attic reconstruction, and 22 received bone pate. Recurrent cholesteatoma occurred in 19.23% of the cartilage group but none in the bone pate group (p = .001). Ear discharge was observed in 19.23% of the cartilage group and 18.18% of the bone pate group, while tympanic membrane perforations and external auditory canal cholesteatoma were more prevalent in the cartilage group.

Conclusions and Significance

Our study indicates that bone pate results in significantly lower cholesteatoma recurrence than cartilage grafting in CWU mastoidectomy attic reconstruction. Bone pate offers stability and favorable long-term outcomes for outer attic wall repair.

Chinese Abstract

背景

胆脂瘤手术涉及耳道壁向下 (CWD) 和耳道壁向上 (CWU)乳突切除术。 CWU 与较高的胆脂瘤复发相关, 通常与耳顶回缩凹陷有关。 用软骨或骨板重建耳顶缺乏比较性证据。

目的

比较CWU 乳突切除术治疗胆脂瘤时, 软骨和骨板在耳顶重建中的有效性。

材料和方法

我们在约旦阿卜杜拉国王大学医院(KAUH)进行了一项回顾性研究, 分析了 2011 年至 2021 年期间进行的手术。包括了接受 CWU 乳突切除术和使用耳屏软骨与软骨膜或骨板进行耳顶重建的患者。

结果

在所分析的 48 名患者中, 26 名接受了软骨移植耳顶重建, 22 名接受了骨板治疗。软骨组复发性胆脂瘤发生率为 19.23%, 而骨板组无复发性胆脂瘤(p=.001)。 软骨组的 19.23%患者 和骨板组的18.18% 患者观察到耳部分泌物, 而鼓膜穿孔、外耳道胆脂瘤更多见于软骨组。

结论和意义

我们的研究表明, CWU乳突耳顶重建中, 骨板导致比软骨移植低得多的胆脂瘤复发率。 骨板为耳顶外壁修复提供稳定性和良好的长期效果。

Keywords:

• Cholesteatoma
• mastoidectomy
• attic reconstruction
• bone pate
• cartilage
• Jordan

Ethical considerations and consent

The Institutional Review Board (IRB) at King Abdullah University Hospital (KAUH) and Jordan University of Science and Technology (JUST) approved the study. The study was performed in accordance with the principles of the Declaration of Helsinki, 1975. An informed consent was waived by the institutional review board committee due to the retrospective nature of the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study received no funding.