Reversible canal wall down tympanomastoidectomy. An alternative to intact canal wall and canal wall down mastoidectomy procedures.

OBJECTIVE: To avoid the limitations of canal wall down surgery yet maintain the exposure provided by canal wall down mastoidectomy, the authors have developed a completely "reversible" canal wall down mastoidectomy technique. The purpose of this case report is to determine the feasibility of the "reversible" canal wall down mastoidectomy technique in the treatment of a patient with an aural cholesteatoma. STUDY DESIGN: Having refined the surgical technique using cadaver temporal bones, the "reversible" canal wall down mastoidectomy was performed in a patient with a recurrent aural cholesteatoma. SETTING: The surgical technique was refined in the Carolina Ear Research Institute's temporal bone dissection lab. The patient underwent the surgical procedure by JTM in a standard operating room setting at a private hospital in Raleigh, North Carolina. PATIENTS: The patient was a private patient, referred to the Carolina Ear & Hearing Clinic for treatment of recurrent cholesteatoma. INTERVENTION: A "reversible" canal wall down mastoidectomy was performed in this patient. MAIN OUTCOME MEASURES: The surgeon determined the adequacy of cholesteatoma exposure following temporary removal of the posterior bony canal wall. Intra-operatively, the surgeon assessed the repositioned posterior bony canal segment, looking specifically at its stability and the absence of gaps along the canal cuts. RESULTS: Temporary removal of the posterior bony canal wall improved exposure of the cholesteatoma and facilitated cholesteatoma removal. The repositioned bony canal segment was well stabilized by the bone cement (Oto-cem) and no gaps were noted along the canal cuts. CONCLUSION: Although it is premature to compare the effectiveness of the "reversible" canal wall down technique to other mastoidectomy procedures, this case confirms the feasibility of this approach.