CHOLESTEATOMA SURGERY TODAY

Four present-day surgical techniques are reviewed to assess their resp ective merits in surgery for cholesteatoma. The oldest method with an open cavity in ears with mastoid extension of cholesteatoma if combine d with partial obliteration is still suitable for less experienced sur geons. Transcanal atticotympanotomy is suitable for limited epitympani c and tympanic cholesteatomas as long as it provides a direct view of the operative field. In similar ears, canal wall up surgery is employe d if, additionally, mastoidectomy is needed because of chronic inflamm ation. Canal wall down surgery with full cavity obliteration with a mu sculoperiosteal flap, bone chips and bone pate should be the method of choice for all cholesteatomas extending beyond the facial nerve canal . The canal skin is kept as an intact tube and provides quick healing. Open cavities should be revised using similar obliteration techniques but, because of the lack of an intact canal skin tube, making use of a large modified Korner skin flap.