The Role of Grafting in Canal Wall down Mastoidectomy

Abstract

Background: Radical mastoidectomy is the outstanding standard technique for management of cholesteatoma. Long term studies  showed increasing incidence of discharging cavities (1). Modified radical mastoidectomy was described to prevent recurrent  cholesteatoma along with reconstruction of the ossicular hearing mechanismre. Exteriorization of the disease bearing areas is essential  for effective follow up (2). However, there are many recesses which cannot be exteriorized regarding its anatomical location such as the  mesotympanum. It will be a source of discharge or accumulation of keratin. Covering these recesses by grafting is an essential rather  than optional step in all radical mastoidectomies to prevent problematic cavities.

Aim of work: Demonstrate the necessity of grafting in  radical mastoidectomy for obtaining dry cavity.

Methods: A prospective, comparative study conducted from March 2016 to October 2019  on 60 cholesteatoma patients. Patients were randomized into 2 equal groups of 30 patients each. In group A, patients undergone modified radical mastoidectomy with grafting, while patients in group B have undergone radical mastoidectomy without grafting.  Regular follow-up was done monthly for 1 year for both groups.

Results: In group A, 22 patients have intact grafts, and dry well epithelialized cavities, 2 patients had perforated grafts, 5 patients had small discharging granulations and 1 patient had a keratin pearl  under the graft. In group B, 19 patients suffered persistent discharging cavity, 8 patients had less discharge with keratin debris and  granulations and 3 patients had dry cavities.

Conclusions: Grafting is an essential step in radical mastoidectomy to prevent cavity  problems.