Reversible canal wall down tympanomastoidectomy - An alternative to intactcanal wall and canal wall down mastoidectomy procedures

Objective: To avoid the limitations of canal wall down surgery yet maintain the exposure provided by canal wall down mastoidectomy, the authors have d eveloped a completely "reversible" canal wall down mastoidectomy technique. The pur pose of this case report is to determine the feasibility of the "r eversible" canal wall down mastoidectomy technique in the treatment of a pa tient with an aural cholesteatoma. Study Design: Having refined the surgical technique using cadaver temporal bones, the "reversible" canal wall down mastoidectomy was performed in a pa tient with a recurrent aural cholesteatoma. Setting: The surgical technique was refined in the Carolina Ear Research In stitute's temporal bone dissection lab. The patient underwent the surgical procedure by JTM in a standard operating room setting at a private hospital in Raleigh, North Carolina. Patients: The patient was a private patient, referred to the Carolina Ear & Hearing Clinic for treatment of recurrent cholesteatoma. Intervention: A "reversible" canal wall down mastoidectomy was performed in this patient. Main Outcome Measures: The surgeon determined the adequacy of cholesteatoma exposure following temporary removal of the posterior bony canal wall. Int ra-operatively, the surgeon assessed the repositioned posterior bony canal segment, looking specifically at its stability and the absence of gaps alon g the canal cuts Results: Temporary removal of the posterior bony canal wal l improved exposure of the cholesteatoma and facilitated cholesteatoma remo val. The repositioned bony canal segment was well stabilized by the bone ce ment (Oto-cem) and no gaps were noted along the canal cuts. Conclusion: Although it is premature to compare the effectiveness of the "r eversible" canal wall down technique to other mastoidectomy procedures, thi s case confirms the feasibility of this approach.