Canal Wall Down Tympanoplasty for Cholesteatoma

Abstract

The advantages and the hints and pitfalls of the canal wall down tympanoplasty for the acquired middle ear cholesteatoma were elaborated.
The canal wall down tympanoplasty is a safe procedure for an ear having a risk factor for reformation of the retraction pocket of the tympanic membrane, especially for those with sniffing habit caused by insufficient closure of the eustachian tube.
The mastoidectomy should be performed in a manner to saucerize the cortical bone and the tegmental border to expose the dural plate to ensure the complete removal of the cholesteatoma matrix and the pneumatic cells in this area. The horizontal portion of the facial nerve should be identified before taking down the posterior canal wall to prevent the injury to the facial nerve. The entrance of the external auditory meatus should be enlarged by removing a portion of the conchal cartilage to support the self-cleansing and the ventilation of the created cavity. In an ear with relatively good pneumatisation of the mastoid, the mastoid tip and the anterior end of the attic should be obliterated using a piece of cartilage or soft tissue materials, such as pedicled fascial flap or musculo-periosteal flap.