External auditory canal reconstruction and mastoid cavity obliteration with composite multi-fractured osteoperiosteal flap: a preliminary study

Year 2006, Volume: 16 Issue: 3, 127 - 131, 30.06.2006

Cevat Uçar

Abstract

Objectives: Öpen cavity mastoidectomy techniques cause some cavity problems. We used inferior pedi- cled composite multi-fractured osteoperiosteal flap which is our original surgical approach to obliterate the mastoid cavity and reconstruct the external audi­ tory canal EAC to prevent the öpen cavity problems.Patients and Methods: Composite multi-fractured osteoperiosteal flap was used to obliterate the mas­ toid cavity and reconstruct the EAC in four patients 2 females, 2 males; mean age 34; range 31 to 38 years who previously underwent radical mastoidec­ tomy to treat the chronic otitis media with cholesteatoma. Small meatoplasty was applied in ali 4 patients to relive their aesthetical concerns. Ali our patients were followed up for two years.Results: The epitelization of the new EAC in our patients was complete at the end of the second month.Cholesteatoma, granulation, and recurrence of osteitis didn’t occur in any of the 4 patients. We detected the new bone formation filling the mastoid cavity in the the postoperative temporal bone CT scanning images.Conclusion: We had an almost natural EAC which owed its existence to the neo-osteogenesis that grows behind the composite multi-fractured osteoperiosteal flap which we use to obliterate the mastoid cavity and to reconstruct the EAC.

Keywords

Ear canal/anatomy & histology/surgery, mastoid/surgery, otitis media/surgery, surgical flaps

Komposit çokkırıklı osteoperiostal flep ile mastoid kavile obliterasyonu ve dış kulak yolu rekonstrüksiyonu: On çalışma

Abstract

Amaç: Açık kavite mastoidektomi uygulandığındabazı kavite sorunları ortaya çıkmaktadır. Çalışmamızda, mastoid kavite obliterasyonu ve dış kulak yolu rekonstrüksiyonu için, kendi geliştirdiğimiz inferiorpediküllü kompozit çokkırıklı osteoperiostal flebi kullanarak açık kavite sorunlarını gidermeyi amaçladık.Hastalar ve Yöntemler: Kolesteatomlu kronik otitismedia tanısıyla radikal mastoidektomi uygulanandört hastaya mastoid kavite obliterasyonu ve dış kulak yolu rekonstrüksiyonu için kompozit çokkırıklı osteoperiostal flep kullanıldı. Ayrıca hastalarda estetik kaygıya neden olmamak için hastaların dördüne de küçükbir meatoplasti uygulandı. Hastalar en az iki yıl takipedildi.Bulgular: Hastalarda oluşturduğumuz yeni dış kulakyolu epitelizasyonu iki ay içinde tamamlandı. Hastaların hiçbirinde kolesteatom, granülasyon ve osteit rekürrensi görülmedi. Ameliyat sonrası temporalkemik tomografilerinde mastoid kaviteyi dolduranyeni kemik oluşumu saptandı.Sonuç: Mastoid kavite obliterasyonu ve dış kulakyolu rekonstrüksiyonunda kullandığımız, kompozitçokkırıklı osteoperiostal flebin altında gelişen neoosteogenesis ile dış kulak yolu anatomisine yakın birkavite elde edildi

Keywords

Kulak kanalı/anatomi ve histoloji/cerrahi, otitis media/cerrahi, cerrahi flep

References

• Ojala K, Sorri M, Sipila P, Palva A. Late changes in ear canal volumes after mastoid obliteration. Arch Otolaryngol 1982;108:208-9.
• Jackson CG, Schall DG, Glasscock ME 3rd, Macias JD, Widick MH, Touma BJ. A surgical solution for the dif- ficult chronic ear. Am J Otol 1996;17:7-14.
• Dornhoffer JL. Surgical modification of the difficult mastoid cavity. Otolaryngol Head Neck Surg 1999; 120:361-7.
• Mosher HP. A method of filling the excavated mastoid with a flap from the back of auricle. Laryngoscope 1911;21:1158-63.
• Black B. Mastoidectomy elimination: obliterate, recon- struct, or ablate? Am J Otol 1998;19:551-7.
• Kahramanyol M. Fascioperiosteal flap and neoosteo- genesis in radical mastoidectomy. Ear Nose Throat J 1992;71:70-2, 75-7.
• Kahramanyol M, Ozunlu A, Pabuscu Y. Fascioperiosteal flap and neo-osteogenesis in radical mastoidectomy: long-term results. Ear Nose Throat J 2000;79:524-6.
• Sade J, Weinberg J, Berco E, Brown M, Halevy A. The marsupialized (radical) mastoid. J Laryngol Otol 1982; 96:869-75.
• Gorur K, Ozcan C, Unal M, Vayisoglu Y. Causes of fail- ure in open cavity mastoidectomy. Kulak Burun Bogaz Ihtis Derg 2002;9:179-83.
• Hoffmann DF, Fagan PA, Taylor B. Reduction meato- plasty. Laryngoscope 1997;107:1127-8.
• Grundnes O, Reikeras O. The importance of the hematoma for fracture healing in rats. Acta Orthop Scand 1993;64:340-2.
• Ozaki A, Tsunoda M, Kinoshita S, Saura R. Role of fracture hematoma and periosteum during fracture healing in rats: interaction of fracture hematoma and the periosteum in the initial step of the healing process. J Orthop Sci 2000;5:64-70.
• Einhorn TA. The cell and molecular biology of fracture healing. Clin Orthop Relat Res 1998;(355 Suppl):S7-21.