Reconstruction Of Middle Ear With Old Radical Cavity

Abstract

A technique of surgical reconstruction of the middle ear, subjected previously to a radical mastoidectomy, using only autogenous grafts, is presented. Missing bony canal walls are reconstructed with tragal cartilage and its skin lining-by using the epidermal lining of the mastoid bowl. All squamous epithelium is removed from the middle ear spaces, great care being taken to preserve the mucoperiosteum. No attempt is made to obliterate or diminish the mastoid cavity which should remain in communication with the reconstructed tympanic cavity, no retroauricular drainage then being necessary. Suitable ossiculoplasty, usually of the columellar type, utilizing any ossicular remnants, autogenous bone or cartilage, is performed. For total or subtotal myringoplasty a large fascial graft is used. In all 22 patients thus operated on a completely healed middle ear, with integrity of all grafts, was obtained. In 6 cases with a follow-up of 16 months to 4 years slightly enlarged reconstructed ear canal and a restored, sometimes less mobile tympanic membrane were found. Postoperative measurements of the canal size in two diameters: vertical and transverse, have been carried out. Functional long-term results were good in all but one case, the air-bone gap being diminished to 10-25 dB.