Deep temporalis fascia in tympanomastoid reconstruction

Various techniques have been described in the reconstruction of mastoidectomy cavity in an attempt to minimize or control the problems of persistent postoperative otorrhoea. We report the efficacy of deep temporalis fascia and its pedicled flap in 34 cases. Retrospective study method was used. There were 34 cases, 19 males and 13 females, the age ranged between 5 and 64 years, mean of 28 years. The clinical pathology included mastoiditis which was common to all the patients, others are middle ear polyp in 7, mastoid abscess 6, meningitis 4, lateral sinus thrombosis 3 and cholesteatoma 2. Comorbidity factors included diabetes mellitus in 2, moderate anaemia in 3 and septicaemia in 7. The procedures comprised of 18 modified radical mastoidectomy (MRM) and 8 atticoantrostomy (AA) with lining of the resulting cavity and tympanoplasty using a pedicled temporalis fascia flap; and 8 cortical mastoidectomy (CM) and tympanoplasty using a graft. The success rate in terms of control of otorrhoea was 55% and there was no case of postoperative wound infection, an improvement compared to an earlier report. In addition there was a reduction in terms of postoperative hospital stay to an average of 9 days. We found the technique simple to learn and needing minimal equipment, hence relevant to otolaryngologic practice in a resource--poor environment. In addition the deep temporalis fascia is an autologous tissue with no risk of immune rejection. We recommend that mastoid reconstruction with the temporalis fascia becomes a routine in mastoidectomy so as to achieve control of chronic discharging ear, particularly in the sub-Saharan Africa where this is still predominant.