"Three cartilages" technique in intact canal wall tympanoplasty to prevent recurrent cholesteatoma

Residual cholesteatoma is the consequence of leaving squamous epithelium in the mastoid and middle ear cleft. It has been demonstrated that the only effective way to reduce the risk of epidermoid cyst neoformation is meticulous and radical removal of cholesteatoma matrix and staging of the operation, regardless of whether a closed or open mastoid cavity tympanoplasty technique has been performed. Recurrent cholesteatoma usually occurs after intact canal wall tympanoplasty secondary to middle ear, attic, and mastoid retraction of the graft, especially in cases with destruction of the scutum or absence of malleus and incus; this is still considered a major problem with this surgical technique. During the last five years we have been performing a procedure we have developed to avoid this retraction. Concave autogenous cartilage from the upper part of the concha auriculae trimmed in three pieces to protect attic, mastoid, and middle ear for graft retraction has been successfully used in 106 surgical procedures. This study describes the surgical technique and analyzes the anatomic and hearing results.