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Transfacial recess ossicular reconstruction: technique and early results
1Department of Otolaryngology, Head and Neck Surgery, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. nblevins@tufts-nemc.org
Objectives:
The objective of this study was to present the technique of transfacial recess ossicular chain reconstruction (TFROCR) for potential use in selected patients with cholesteatoma.
Study Design:
The author conducted a retrospective case review of all candidates for TFROCR between August 1998 and March 2003.
Setting:
A tertiary referral center.
Patients:
At first-stage tympanomastoidectomy, 22 ears (21 patients; 8 children and 13 adults) with cholesteatoma and ossicular discontinuity were identified as candidates for TFROCR. Seven patients had undergone previous tympanomastoid surgery.
Intervention:
The first stage included canal wall up mastoidectomy with resection of disease, wide opening of the facial recess, cartilage graft tympanoplasty, and placement of silicone elastomer in the middle ear. Approximately 6 months later, patients underwent a second-stage postauricular procedure. Endoscopes were used to inspect the middle ear through the facial recess. When possible, TFROCR was then performed without elevating a tympanomeatal flap.
Main Outcome Measures:
Variations in anatomy, disease control, and hearing results were studied.
Results:
Of the 22 candidate ears, 17 successfully underwent TFROCR, whereas 5 required traditional second-stage procedures with canal incisions. There were no surgical complications. Early hearing results are promising with an average air-bone gap of less than 20 dB. There have been no early failures from recurrent disease or prosthesis displacement.
Conclusions:
In carefully selected patients, TFROCR could be safe and effective for disease control and hearing restoration. It could provide for optimal prosthesis placement and almost immediate hearing improvement, avoiding the need for canal incisions, middle ear packing, and dry ear precautions. One must consider the potential risk of missing residual disease secondary to limited exposure.