[How to create a self-cleaning open mastoid cavity]

Our experience from multiple open mastoid cavity revisions is that some of the well-proven techniques to create a self-cleaning small open cavity are not anymore practiced everywhere.The crucial steps are to considerably drill down the facial ridge, as well as the lateral bone (to the level of the sigmoid sinus) and - in cases of a well pneumatized mastoid - to ground down the mastoid tip. The bony rims should be smoothened with a diamond burr. Furthermore, the size of the cavity can be reduced by partial obliteration of the retrofacial space and the sinus-dura-angle using bone substitutes. In our hands cartilage chips have proven to be a good substitute, hydroxy apatite pellets or a musculoperiosteal flap according to Palva might be used alternatively. Finally a wide auditory canal entrance has to be created. By applying these techniques, for a selected number of cases the "open technique" still represents an essential part of cholesteatoma surgery these days.