Cartilage reconstruction of the scutum defects in canal wall up mastoidectomies

This study was performed to evaluate whether cartilage reconstruction of scutal wall defects diminishes retraction pocket and recurrent cholesteatoma, as compared with no cartilage reconstruction of the scutal defect.

A retrospective chart review from 1980 to 1993 was performed on all patients undergoing a canal wall up mastoidectomy. These procedures were done in a large teaching hospital where some surgeons reconstructed with cartilage and others did not. The recurrence rate of cholesteatoma and retraction pockets, as well as the need for further surgery, was assessed.

There were 103 canal wall up mastoidectomies performed, and 84 patients were available for long term follow-up. Of these, 52 were not reconstructed with cartilage, whereas 32 were reconstructed with cartilage. Of the 52 patients not reconstructed, 47% did not develop retraction pockets. Of the 53% who did develop a retraction pocket, only one third required further surgery, and the others were managed in the office. Of the 32 patients that were reconstructed with cartilage, 66% did not develop further retractions. Of the 34% who did develop a retraction pocket, one third required further surgery. In both groups, those who did require further surgery did have recurrent cholesteatoma as well.

It would appear that reconstruction of scutal wall defects after canal wall up mastoidectomies with cartilage may be of some benefit in preventing further retraction pockets and thus the recurrence of cholesteatoma.