En bloc mastoidectomy to avoid postoperative retroauricular deformity in the transpetrosal approach

The authors describe a surgical technique to avoid postoperative retroauricular deformity following the transpetrosal approach. After removing a one-piece temporal and suboccipital bone flap, the mastoid process is cut obliquely by using a sagittal saw towards an imaginary line drawn from the point on the petrous ridge just lateral to the arcuate eminence to the burr hole opened medial to the occipital groove. This technique allows en bloc removal of the mastoid process without resulting bone defects. Three patients who were treated with this technique and followed up for more than 1 year showed good cosmetic results with no complications including cerebrospinal fluid leakage. We believe this en bloc mastoidectomy offers a definite advantage in regard to avoid postoperative retroauricular deformity.