Hydroxyapatite canal wall reconstruction/mastoid obliteration

The controversy regarding removal of the posterior external canal wall during mastoid surgery spans many decades. There are inherent advantages and disadvantages to either removing or not removing the canal wall. The operation must be tailored to the patient and his or her unique situation. We describe our experience with external canal wall reconstruction and mastoid obliteration with hydroxyapatite in an effort to derive the best of both philosophies. Hydroxyapatite has been used in 3 different forms including granules, a preformed canal wall prosthesis, and with a block of hydroxyapatite sculpted to fit the individual defect. A total of 36 patients with up to 54-month follow-up are reported. Details of the techniques used, with advantages and pitfalls, are described.