Mastoid Reduction in Combination with Corner-Tag Meatoplasty: Refining Mastoidectomy and Canalplasty Outcomes

Abstract

Objectives:

Prevention of “a problem cavity” following modified radical mastoidectomies (MRM) and canalplasties requires careful preoperative consideration and an adept surgical technique. We aim to describe our technique of a superiorly-based middle temporal artery flap, with an inferiorly-based musculoperiosteal flap, in combination with a Corner-Tag-meatoplasty, and to evaluate the surgical outcomes on a semi-quantitative scale.

Methods:

Retrospective consecutive case review from 2010-2013. Primary end-point measure of creating a low maintenance dry mastoid cavity was graded using Merchant’s grading system.

Results:

Twenty-four patients (13 males and 11 females) with a mean age of 42.6 years (range, 17-76 years) were included. All except 3 cases were primary ear cases. None had previous reduction procedures done. Nineteen cases were MRMs, 3 were revision mastoidectomies, and 2 were canalplasties. A well-epithelized, dry mastoid cavity was achieved in 12 patients by 1-month post surgery, with another 9 achieving this by 3-months. Twenty-three cases (96%) resulted in cavities with adequate control of infection based on Merchant’s summary grade. The cavities took an average of 1.75 months to epithelize. Three patients had recurrent tympanic membrane perforation with one requiring revision surgery. None had disease recurrence at mean 15.8 months follow-up (range, 6-25 months). Our technique of meatoplasty allowed excellent visualization of the mastoid bowl affording bimanual instrumentation in the clinic setting.

Conclusion:

The middle temporal artery and inferior musculoperiosteal flap in combination with the Corner-Tag meatoplasty is an effective technique in reducing the mastoid cavity, aiding epithelization, has low complication rates, and allows good surveillance postoperatively.