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.

Duke Scholars

Author Gregory Fabian Hulka Head and Neck Surgery & Communication Sciences