Retrograde mastoidectomy technique - retrospective analysis of results

Authors

DOI:

https://doi.org/10.34631/sporl.2040

Keywords:

Mastoidectomy, Retrograde technique

Abstract

Objective: Analysis of the results of mastoidectomy using the retrograde technique for removal of cholesteatomas in adults.
Methods: Retrospective analysis of cases of mastoidectomy via retrograde technique performed at Centro Hospitalar Tondela-Viseu between January 2018 and December 2021 with collection of demographic data, type of surgery, reconstruction of the posterosuperior wall of the canal, type of tympanoplasty, recurrence, follow-up time and audiometric results.
Results: 45 ears were included in the study, 73.3% of which corresponded to primary surgery. Reconstruction of the posterosuperior wall of the canal was performed in 37.8% and ossiculoplasty was done in 73.3%. The air-bone gap gain, in patients who underwent wall reconstruction was 9.66dB (vs. 1.91 dB without reconstruction). During follow-up, recurrence occurred in 13.3% of cases.
Conclusions: In our series, this technique proved to be safe and effective in cholesteatoma excision. Reconstruction of the EAC wall allowed better audiometric results.

References

Chole RA; Sharon JD. Chronic Otitis Media, Mastoiditis and Petrositis. In: In: Flint PW, Haughey BH, Lund VJ, Niparko JK, et al (Eds.) Cummings Otolaryngology, Head and Neck Surgery. 7th ed. Philadelphia: Elsevier; 2020. p. 2120-2126.

Alam M, Chandra K. Ears with cholesteatoma: outcomes of canal wall up and down tympano-mastoidectomies-a comparative prospective study. Indian J Otolaryngol Head Neck Surg. 2022 Aug;74(Suppl 1):730-736. doi: 10.1007/s12070-021-02549-1.

Castle JT. Cholesteatoma pearls: practical points and update. Head Neck Pathol. 2018 Sep;12(3):419-429. doi: 10.1007/s12105-018-0915-5.

Dornhoffer JL. Retrograde mastoidectomy with canal wall reconstruction: a single-stage technique for cholesteatoma removal. Ann Otol Rhinol Laryngol. 2000 Nov;109(11):1033-9. doi: 10.1177/000348940010901108.

Dornhoffer JL. Retrograde mastoidectomy with canal wall reconstruction: a follow-up report. Otol Neurotol. 2004 Sep;25(5):653-60. doi: 10.1097/00129492-200409000-00002.

Hatano M, Ito M, Yoshizaki T. Retrograde mastoidectomy on demand with soft-wall reconstruction in pediatric cholesteatoma. Acta Otolaryngol. 2010 Oct;130(10):1113-8. doi: 10.3109/00016481003709861.

Harris AT, Mettias B, Lesser TH. Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery. J Laryngol Otol. 2016 Mar;130(3):235-41. doi: 10.1017/S0022215116000013.

Corrales CE, Blevins NH. Imaging for evaluation of cholesteatoma: current concepts and future directions. Curr Opin Otolaryngol Head Neck Surg. 2013 Oct;21(5):461-7. doi: 10.1097/MOO.0b013e328364b473.

Kanneganti P, Harris JD, Brophy RH, Carey JL, Lattermann C, Flanigan DC. The effect of smoking on ligament and cartilage surgery in the knee: a systematic review. Am J Sports Med. 2012 Dec;40(12):2872-8. doi: 10.1177/0363546512458223.

Kerckhoffs KG, Kommer MB, van Strien TH, Visscher SJ, Bruijnzeel H, Smit AL. The disease recurrence rate after the canal wall up or canal wall down technique in adults. Laryngoscope. 2016 Apr;126(4):980-7. doi: 10.1002/lary.25591.

Hakuba N, Hato N, Shinomori Y, Sato H, Gyo K. Labyrinthine fistula as a late complication of middle ear surgery using the canal wall down technique. Otol Neurotol. 2002 Nov;23(6):832-5. doi: 10.1097/00129492-200211000-00003.

Kim BG, Kim HJ, Lee SJ, Lee E, Lee SA, Lee JD. Outcomes of modified canal wall down mastoidectomy and mastoid obliteration using autologous materials. Clin Exp Otorhinolaryngol. 2019 Nov;12(4):360-366. doi: 10.21053/ceo.2018.01333.

Dankuc D, Vlaški L, Pejaković N. Techniques of the tympanomastoidectomy with reconstruction of the posterior bone wall of the external auditory canal. Srp Arh Celok Lek. 2015 Jul-Aug;143(7-8):480-6. doi: 10.2298/sarh1508480d.

Bahmad F Jr, Carasek N, Lamounier P. Titanium prostheses versus stapes columella type 3 tympanoplasty: a comparative prospective study. Braz J Otorhinolaryngol. 2022 Jul-Aug;88(4):562-569. doi: 10.1016/j.bjorl.2020.07.014.

Tos M, Poulsen G. Attic retractions following secretory otitis. Acta Otolaryngol. 1980 May-Jun;89(5-6):479-86. doi:10.3109/00016488009127165.

Yung M, Tono T, Olszewska E, Yamamoto Y, Sudhoff H, Sakagami M, Mulder J, Kojima H, İncesulu A, Trabalzini F, Özgirgin N. EAONO/JOS Joint Consensus Statements on the Definitions, Classification and Staging of Middle Ear Cholesteatoma. J Int Adv Otol. 2017 Apr;13(1):1-8. doi: 10.5152/iao.2017.3363.

Published

2024-03-24

How to Cite

Mourão, M., Quadros, G., Rodrigues, B., Patrão, F., Alves, A., & Raposo, S. (2024). Retrograde mastoidectomy technique - retrospective analysis of results. Portuguese Journal of Otorhinolaryngology and Head and Neck Surgery, 62(1), 37–44. https://doi.org/10.34631/sporl.2040

Issue

Section

Original Article