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Hybrid Technique Used for Mastoid Canal Wall Reconstructions

Modern Mastoid Surgery: Canal Wall Reconstruction
1:00 – 2:00 pm
Tuesday
Room E451A

Surgeons have long debated the merits of canal-wall-up versus canal-wall-down approaches to treating chronic otitis media with cholesteatoma. The canal-wall-down approach provides better access but requires repeated surgical visits for debridement and drainage. The canal-wall-up approach keeps the ear dry, but has higher rates of recidivism. A hybrid approach that reconstructs the canal wall offers the advantages of both.

“Canal wall reconstruction gives us the same access to the mastoid as the canal-wall-down procedure,” said Bruce Gantz, MD, professor and head of otolaryngology—head and neck surgery, at the University of Iowa. “We obliterate the mastoid, which prevents re-retraction of skin into the mastoid because we have blocked it off.”

Dr. Gantz will discuss the hybrid technique during “Modern Mastoid Surgery: Canal Wall Reconstruction.” The advantages of canal wall reconstruction are tremendous, he said, especially for children.

“Our recurrence rates are extremely low, around 2.6 percent,” he said. “It is a wonderful way of removing disease and reassuring patient and family that you’re not going to get a recurrence.”

The procedure is easy to learn, Dr. Gantz said. The canal wall is removed with a micro saw, which provides access similar to the canal-wall-down technique to remove the cholesteatoma. The ear is reconstructed by putting the canal wall back in, blocking the attic with a bone graft from the mastoid tip, and obliterating the mastoid with a bone pate.

The technique isolates the attic and mastoid from the tympanum and prevents recurrent retraction of the tympanic membrane, which is a major cause of recurrence in children with Eustachian tubes that drain poorly. A follow-up surgery six to eight months later assesses results and completes the reconstruction.

Canal wall reconstruction is not a new procedure, but is infrequently used in North America, Dr. Gantz said. He first encountered the technique at an international conference in Sardinia in the mid-1990s. A similar technique of removing and then reconstructing the canal wall was being used in the 1950s.

“We have modified the procedure I learned in the 1990s a bit by using a little better structure of bone in the attic and blocking that with larger pieces of mastoid tip,” he explained. “That seems to help prevent even the slight erosion that might happen in the future. Canal wall reconstruction has been working well for me since the mid-1990s. It is a procedure that will reduce the recidivism that comes with other approaches to a very difficult disease.”

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