Scutumplasty

The indications for revision middle ear surgery are inter-linked to the objectives of surgery and needs of the patient. Revision middle ear surgery is often challengingly arduous not only for the patient but for the surgeon as well. This study concentrates on the causes of failures of primary ear surgery, indications, techniques, outcomes and lessons learned in revision ear surgery. This retrospectivedescriptive study included 22 cases (12.29%) of revision surgery,with a follow up of at least one year, out of total 179 cases of middle ear surgeries performed over a period of 5 years...

OBJECTIVE: To present preliminary results in transmeatal exclusive endoscopic ear surgery. STUDY DESIGN: Retrospective. INTERVENTION: Rigid endoscopes were used for all procedures. A wide posterior tympanomeatal flap was elevated transmeatally, and the scutum was removed with a bone curette or was drilled until visualization of cholesteatoma extension and the mastoid antrum. The malleus and incus were removed when they were involved in the cholesteatoma or restricted access to it...

The objective was to evaluate the long-term clinical outcome of the bony outer attic wall reconstruction (scutumplasty) by using autogenous bone paté in a series of patients who underwent canal wall up (CWU) mastoidectomy for middle ear cholesteatoma. In addition, an histological analysis of bone paté graft specimens taken during the second-look procedure 12 months after the first surgery, was carried out. A series of 134 ears from 128 patients with cholesteatoma who underwent staged CWU mastoidectomy and attic reconstruction with bone paté, between 1995 and 2000 inclusive, was retrospectively analyzed...

Thirty-one cases of cholesteatoma with intact ossicular chain were reviewed to examine the extension of cholesteatoma, operation procedures, pre- and postoperative hearing levels, and postoperative condition of the ear drum. They were operated on at Departments of Hyogo College of Medicine and Osaka University Medical School from 1989-1996, which were 20.4% of all of the primary cholesteatoma cases (n = 152). Twelve cases located at attic were operated by atticotomy or canal wall up and scutumplasty, 17 cases located at attic/antrum were operated by canal wall down and reconstruction, and two cases located around stapes were operated through the ear canal...

This study was carried out to evaluate the anatomical and hearing results of the reparation of attic defects in closed tympanoplasty. Reparation was carried out in 194 patients by using a costal cartilage allograft, and in 159 patients with a bone pate autograft. The follow-up was from 1 to 5 years. The study was not truly randomized owing to an occasional lack of allogenic costal cartilage. In the group 'costal cartilage' a partial resorption was observed in 5.7% and a complete resorption in 4.7% of the cases...

Results of surgery for middle ear cholesteatoma were investigated in 202 ears of 197 patients who had undergone surgery by the staged intact canal wall technique. Surgical procedures used in the second stage for prevention of a retraction pocket were classified into three types: Type S1, no scutumplasty; Type S2, scutumplasty; Type S3, scutumplasty plus mastoid obliteration. Recurrent cholesteatoma was found in 9 ears (4%) and retraction pocket in 47 ears (23%). They occurred between 2 and 120 months (average: 26 months) after the second stage, most frequently at 1 to 3 years...

A high facial ridge is a common feature of open cavity cases presenting for rehabilitation and was present in 25 percent of a series of 223 cases requiring such surgery. A precise scutumplasty and posterior wall repair is required for optimal results. Prior organic methods have been found to be time-consuming, difficult, or unreliable. Current wall prostheses are unsuited in shape to these limited defects. Reconstruction using semicircular porous hydroxylapatite ceramic attic defect plates, has proved simple and effective when combined with posterior wall repair using autograft cartilage or sheets of porous hydroxylapatite ceramic...

In the treatment of cholesteatoma employing intact canal wall tympanoplasty, staging the operation and re-establishment of aeration of the tympanic cavity are required to eradicate possible causes of recurrence, cholesteatoma residue, and retraction pocket. The planned staged tympanoplasty with preventive measures for recurrence has evolved. At the second-stage operation, one of the following three types of operations was performed according to the grade of aeration and healing of tympanic cavity: type S1, only ossiculoplasty; type S2, ossiculoplasty and scutumplasty; and type S3, ossiculoplasty, scutumplasty, and mastoid obliteration...

Thirteen cholesteatomas, with hearing within 20dB, were operated on from 1985 to 1992. Their mean age was 22.1 years, and the mean follow-up period 1.8 years. Eleven cases were pars flaccid type, and 2 cases pars tensa type. Tympanoplasties were performed by the canal down method (4 cases), the canal up method (3 cases), both transmeatal atticotomy and scutumplasty (4 cases) and both the canal down method and mastoid obliteration (2 cases). Postoperative hearing results of three averaged speech frequencies were within 20dB in 11 cases and between 20 and 30dB in 2 cases...

The postoperative hearing results in cases of tympanoplasty, radical mastoidectomy, modified radical mastoidectomy and tympanoplasty combined with modified radical mastoidectomy on 528 ears, performed in the Tokai University Hospital between 1975 and 1980 were assessed. The assessment was based on pure-tone audiograms taken 3 months to 5 years after the operation. Out of 528 cases 70.5% gained better postoperative hearing, 6% showed no change of hearing and 23.5% showed deterioration of hearing. Auditory success of those who attained social hearing, air-bone gap closure to within 20dB or gained hearing of 20 dB or more was 53...

The use of a small plate of autogenous bone to reconstruct a scutum defect--scutumplasty--in combined approach tympanoplasty in 79 patients with attic cholesteatoma has been studied for a period of one or more years. The bone plate obtained from the mastoid cortex and sculptured to the proper size and shape was snugly fitted between two grooves made by a bur at the anterior and posterior bony external canal wall just proximal to the scutum defect. In this series, recurrence of postoperative cholesteatoma in the attic was found in 5...

Incidence of retraction pocket and recurrent cholesteatoma in the attic after surgery for middle ear cholesteatoma using the staged intact canal wall technique were investigated in 95 ears of 91 patients, all of which had various degrees of bone defect in the tympanic scutum. Surgical procedures employed in the second stage for prevention of attic retraction were classified into three types: Type I, no scutumplasty; Type II, scutumplasty; Type III, scutumplasty plus mastoid obliteration. In 83 ears followed up for more than 1 year after the second stage, such retraction troubles occurred in 2 of 13 ears (15%) in Type I, 8 of 20 ears (40%) in Type II, and 24 of 50 ears (48%) in Type III...