1993 Volume 1993 Issue Supplement66 Pages 25-33
Mastoid cavity obliteration using the Palva flap procedure was performed on 51 cases of chronic middle ear disease between 1978 and 1981. These cases included 30 cases of chronic otitis media (COM) and 21 cases of cholesteatoma. In 36 of the 51 (70.6%), the Palva flap procedure was combined with Feldmann's osteoplastic technique to reconstruct the posterior canal wall. In the remaining 15 cases, the Palva flap procedure was perfomed after the canal wall down (CWD) procedure. During the follow-up period of 11 to 14 years,13 of the 51 cases (25.5%) required revision surgery due to subsequent cavity problems. The pathological conditions which necessitated surgery in these 13 cases were cholesteatoma (7 cases), infection (3 cases), ossicular interruption (2 cases) and cyst formation (1 case). The Palva flap procedure combined with Feldmann's osteoplastic technique required a high incidence of revision surgery (11 of 36 cases; 30.6%) compared with the Palva flap procedure with CWD (2 of 15 cases: 13.3%). Noteworthy is the frequent appearance of cholesteatoma after Feldmann's technique (6 of 11 revision cases). The principle problem with this procedure was due to a minute gap that tends to remain between the posterior canal and the re-positioned bone. The canal skin gradually and silently intrudes into the cavity through this gap as the Palva flap atrophies, creating a new cholesteatoma; this condition was seen in revision surgery 95.7 months (52-132 months) after the initial surgery for 3 cases in which the original condition was COM.
