[Reduction of radical cavities by homologous cartilage chips]

The article reviews, first of all, the common obliteration methods of radical cavities. This is followed by a description of the author's own technique which has been practiced for the last 13 years. This method employs preserved (Cialit solution 1:5000) homologous septal cartilage chips, shaped into small cubes of 3-4 mm. size. The chips are implanted in obscure districts (apical mastoid, sinus dura angle) of radical cavities for primary or secondary (old cavities) partial obliteration, as shown in Figs. 1 and 2. Crushed homologous septal cartilage plates and temporal muscle fascia are placed additionally on the chips. The effect is the construction of a small, easy-care cavity, which can be appreciated at a glance. Statistical results of 314 cases (170 cases of primary obliteration, 144 old cavities) are presented. Chips in cavities are well tolerated. Chips were partially rejected in 13 cases only, whereas in 3 cases they were completely rejected. A permanent dry cavity and dry ear was achieved in 86% of the cases. Cholesteatoma recurred in 5 cases. The homologous cartilage technique is contraindicated in fistulas on the labyrinth or fenestra, as well as in exposed facial nerve or dehiscence of the facial nerve canal, in case of healed fistula of the dura, and in dissection of the sinus sigmoideus. In these cases, autologous cartilage (tragus, cavum conchae) must be implanted. One of the most important advantages of this method is that there is no crumpling up of the obliterated areas and no retractions over a longer period of time, compared with other relevant techniques (i.e., pedicled subcutis muscle grafts or free tissue flaps).