Abstract
The objective was to evaluate the long-term clinical outcome of the bony outer attic wall reconstruction (scutumplasty) by using autogenous bone paté in a series of patients who underwent canal wall up (CWU) mastoidectomy for middle ear cholesteatoma. In addition, an histological analysis of bone paté graft specimens taken during the second-look procedure 12 months after the first surgery, was carried out. A series of 134 ears from 128 patients with cholesteatoma who underwent staged CWU mastoidectomy and attic reconstruction with bone paté, between 1995 and 2000 inclusive, was retrospectively analyzed. In ten randomly selected ears, biopsies from the newly built outer attic wall were taken during the second-look operation and were microscopically analyzed. At the second stage operation, the bone paté graft was found normal in 64.9% of cases. In 39 (29.1%) patients there was a remarkable hypertrophy of the bone paté which was subsequently thinned out by using a diamond burr. A partial resorption of the bone paté was observed in 4.4% of ears and a total resorption in 1.4%. Residual cholesteatoma was found in 13.4% of ears. At the last follow-up visit, recurrent cholesteatoma was observed in 5.2% of ears. Self cleaning attic retraction pocket occurred in 4.4% of ears. Twelve months after implantation, histologic examination on the newly built bone showed a well-structured bony tissue. In particular, osteoblasts lined bone trabeculae with signs of an active tissue remodeling. In conclusion, the reconstruction of the outer attic wall should be considered a fundamental step when performing a CWU procedure in order to prevent attic retractions and recurrences of cholesteatoma. In our experience, autogenous bone paté graft has demonstrated good long-term results in outer attic wall reconstruction being adaptable, well tolerated, stable and of low cost.
Similar content being viewed by others
References
Althaus SR (1985) Tympanomastoid surgery: a technique for repairing posterior osseous canal wall defects with autologous temporalis fascia and bone paté. Otolaryngol Head Neck Surg 93:227–229
Bacciu S, Pasanisi E, Perez-Raffo G, Avendano Arambula J, Piazza F, Bacciu A, Govoni M, Guida M, Zini C (1998) Scutumplasty: costal cartilage vs bone paté. Auris Nasus Larynx 25:155–159
Black B (1992) Prevention of recurrent cholesteatoma: use of hydroxyapatite plates and composite grafts. Am J Otol 13:273–278
Chiossone E (1981) “Three Cartilages” technique in intact canal wall tympanoplasty to prevent recurrent cholesteatoma. Am J Otol 6:226–230
Decat M, Polet MA, Gersdorff M (1997) Use of costal cartilage in middle ear surgery. Acta Oto rhino laryngol Belg 51:17–21
Gersdorff MCH, Robillard TAJ (1985) A new procedure for bone reconstruction in oto-microsurgery: a mixture of bone dust and fibrinogen adhesive. Laryngoscope 95:1278–1280
Grote JJ, Van Blitterswijk CA (1986) Reconstruction of the posterior auditory canal wall with hydroxyapatite prosthesis. Ann Otol Rhinol Laryngol 95(Suppl. 123):6–9
Hinohira Y, Yanagihara N, Gyo K (2005) Surgical treatment of retraction pocket with bone pate: scutum plasty for cholesteatoma. Otolaryngol Head Neck Surg 133:625–628
Karmarkar S, Bhatia S, Saleh E, De Donato G, Taibah A, Russo A, Sanna M (1995) Cholesteatoma surgery: the individualized technique. Ann Otol Rhinol Laryng 104:591–595
Lee WS, Choi JY, Song MH, Son EJ, Jung SH, Kim SH (2005) Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket. Otol Neurotol 26:1107–1111
McCleve DE (1969) Tragal cartilage reconstruction of the auditory canal. Arch Otolaryngol 90:271–274
Palva T, Virtanen H (1981) Ear surgery and mastoid air cell system. Arch Otolaryngol 107:71–73
Pappas JJ, Bailey HA Jr, McGrew RN, Graham SS (1981) Homograft septal cartilage for attic support in intact canal wall tympanomastoidectomy and tympanoplasty. Laryngoscope 91:1457–1462
Pfleiderer AG, Ghosh S, Kairinos N, Chaudhri F (2003) A study of recurrence of retraction pockets after various methods of primary reconstruction of attic and mesotympanic defects in combined approach tympanoplasty. Clin Otolaryngol 28:548–551
Portmann M (1966) Le conduit auditif externe osseux dans le tympanoplasties. Rev Laryngol 17:957
Pou J (1977) Reconstruction of bony canal with autogenous bone graft. Laryngoscope 87:1826–1832
Robinson JM (1997) Closed cavity tympanomastoidectomy with bone paté repair of the attic. A continuing study: year 9. In: Sanna M (ed) Cholesteatoma and mastoid surgery, 5th edn. CIC Edizioni Internazionali, Roma, pp 564–566
Sakay M, Shinkawa A, Miyake H, Fujii K (1986) Reconstruction of scutum defects (scutumplasty) for attic cholesteatoma. Am J Otol 7:188–192
Sanna M, Zini C, Gamoletti R, Delogu P, Scandellari R, Russo A, Taibah A (1987) Prevention of recurrent cholesteatoma in closed tympanoplasty. Ann Otol Rhinol Laryngol 96:273–275
Sanna M, Zini C, Scandellari R, Jemmi G (1984) Residual and recurrent cholesteatoma in closed tympanoplasty. Am J Otol 5:277–282
Sheehy JL, Brackmann DE, Graham MD (1977) Cholesteatoma surgery: residual and recorrent desease. A review of 1024 cases. Ann Otol Rhinol Laryngol 86:451–462
Sheehy JL (1988) Cholesteatoma surgery: canal wall down procedures. Ann Otol Rhinol Laryngol 97:30–35
Smyth GDL (1971) Cartilage canalplasty. Laryngoscope 81:786–792
Wehrs R (1972) Reconstructive mastoidectomy with homograft knee cartilage. Arch Otolaryngol 87:1177–1187
Yanagihara N, Gyo K, Sasaki Y, Hinohira Y (1993) Prevention of recurrence of cholesteatoma in intact canal wall tympanoplasty. Am J Otol 14:590–594
Zanetti D, Nassif N, Antonelli AR (2001) Surgical repair of bone defects of the ear canal wall with hydroxylapatite sheets: a pilot study. Otol Neurotol 22:745–753
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bacciu, A., Pasanisi, E., Vincenti, V. et al. Reconstruction of outer attic wall defects using bone paté: long-term clinical and histological evaluation. Eur Arch Otorhinolaryngol 263, 983–987 (2006). https://doi.org/10.1007/s00405-006-0098-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-006-0098-7