LETTERS TO THE EDITOR 389 RETROGRADE MASTOIDECTOMY 2. McQuiston RJ. Endaural radical mastoidectomy for chronic mastoi- ditis. Arch Otolaryngol 1950;51:596 – 607. 3. Moore J. Endaural modified radical mastoidectomy. Laryngoscope To the Editor: I read Dr. Dornhoffer’s article with a great 1957;67:521 – 43. interest (1). It is a well written article. I would like to 4. Nikolopoulos TP, Gerbesiotis P. Surgical management of choles- contribute regarding the technique, retrograde mastoi- teatoma: the two main options and the third way–atticotomy/limited mastoidectomy. Int J Pediatr Otorhinolaryngol 2009;73:1222 – 7. dectomy, also known as of inside-out mastoidectomy, or 5. Roth TN, Haeusler R. Inside-out technique cholesteatoma surgery: a endaural tympanoplasty and mastoidectomy (2 – 5). I retrospective long-term analysis of 604 operated ears between 1992 gained exposure to this technique during my otology and 2006. Otol Neurotol 2009;30:59 – 63. fellowship at Chicago Ear Institute and also by observing my late father, Dr. Osman Mamıkog ˘ lu, during my residency. RESPONSE TO LETTER TO THE EDITOR: The main advantage of this technique is to initiate the ‘‘LONG-TERM COMPLICATIONS AND surgery from where the disease cholesteatoma has SURGICAL FAILURES AFTER started, thus from the epitympanic membrane. Instead OSSICULOPLASTY’’ of removing a significant amount of cortical mastoid bone to reach to the disease, the surgeon by following In Reply: Thank you for your interest and commentary the disease/retraction pocket/cholesteatoma will initiate regarding the surgical techniques employed in our case the surgery from the external auditory canal. The bone series (1). This is a succinct description of the procedures removal is continued parallel to lateral process of malleus used to eradicate cholesteatoma and facilitate reconstruc- and following the disease. Once both anterior epitym- tion of the external auditory canal wall and tympanic panic recess and superior ligament is clearly identified, membrane. In cases where extent of disease or other bone removal toward incudomalleal articulation can be factors may preclude the use of this canal wall recon- continued to until the surgeon has a clear view of tegmen struction technique (i.e., inadequate remnant bony canal and later short process of incus. I usually use a smaller wall to allow a cartilage graft to traverse the defect, coarse diamond on lower speed until the attictomy phase previous canal wall down mastoidectomy, etc.), we is completed. At this very phase of surgery, the surgeon perform mastoid obliteration using demineralized bone will have a good idea regarding the extent of the disease. matrix mixed with cartilage chips (2 – 4) or the vertical The major advantage of the retrograde mastoidectomy is juxtaposition junction (VJJ) soft tissue flap (5). the ability of identification of tegmen and facial nerve in the middle ear at the beginning of the surgery. From this Matthew D. Cox, M.D. point the bone removal of mastoid and over the facial Joshua Cody Page, M.D. ridge can be done as much as needed. The mastoid cavity John L. Dornhoffer, M.D. using this method will usually be smaller than the University of Arkansas for Medical Sciences mastoidectomy. I also would like to point out the import- Little Rock, Arkansas ance of using conchal (auricular) cartilage as mentioned email@example.com by Dr. Dornhoffer’s in his previous articles. Conchal cartilage has a nice curvature and is more flexible, if Aaron Trinidade, F.R.C.S. necessary larger pieces can be removed. The scaring and deformity after harvesting conchal cartilage is minimal Southend Hospital NHS Trust unless excessive tissue is harvested. I usually use the Essex, England conchal cartilage to partially obliterate mastoid bowl or for grafting the large perforation or retraction. The authors disclose no conflicts of interest. DOI: 10.1097/MAO.0000000000001725 Bulent Mamikoglu, M.D. Department of Neurosurgery REFERENCES Peoria School of Medicine 1. Cox MD, Page JC, Trinidade A, Dornhoffer JL. Long-term compli- University of Illinois cations and surgical failures after ossiculoplasty. Otol Neurotol Peoria, Illinois 2017;38:1450 – 5. 2. Dornhoffer JL. Surgical modification of the difficult mastoid cavity. firstname.lastname@example.org Otolaryngol Head Neck Surg 1999;120:361 – 7. 3. Leatherman BD, Dornhoffer JL. The use of demineralized bone The author discloses no conflicts of interest. matrix for mastoid cavity obliteration. Otol Neurotol 2004;25:22 – 5. discussion 25-6. DOI: 10.1097/MAO.0000000000001724 4. Cox MD, Dunlap QA, Trinidade A, Dornhoffer JL. Long-term outcomes after secondary mastoid obliteration. Otol Neurotol REFERENCES 2016;37:1358 – 65. 5. Trinidade A, Norton J, Dornhoffer JL. The vertical juxtaposition 1. Cox MD, Page JC, Trinidade A, Dornhoffer JL. Long-term compli- junction (VJJ) flap - a useful flap in mastoid obliteration surgery: our cations and surgical failures after ossiculoplasty. Otol Neurotol long-term experience in twenty patients. Clin Otolaryngol 2017;42: 2017;38:1450 – 4. 756 – 8. Otology & Neurotology, Vol. 39, No. 3, 2018 Copyright © 2018 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
Otology & Neurotology – Wolters Kluwer Health
Published: Mar 1, 2018
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