![]() ![]() Moffat and colleagues described the use of bone pate´ and a superiorly based temporalis mucoperiosteal flap for mastoid obliteration. Palva described a mentally based musculo periosteal flap in combination with the use of cortical bone chips and bone pate´ for mastoid obliteration. Many techniques for mastoid obliteration have been described in the literature. These concerns have led some to primarily advocate the use of Canal-Wall-Up (or Intact Canal Wall) mastoidectomies or propose the reconstruction of the ear canal-mastoid partition. Open mastoid procedures have been criticized for the unfavorable cosmetic appearance due to a large meatoplasty, the need for regular cleaning, as well as the increased incidence of discharge and recurrent infections. Despite careful observation of best practices including mastoid saucerization, removal of the mastoid tip, lowering of the facial ridge, and creation of an adequate-size meatus, moisture may still persist in areas of the mastoid bowl leading to stasis of mucoid exudate, localized areas of infection, and underlying mucosal changes. Exteriorization of attic, mastoid and middle ear with a CWD mastoidectomy has a high rate of success in achieving a safe and dry ear, but there is a need for continuous inspection of the cavity and a high incidence of moisture resulting in discharge, Persistent moisture, infection, and discharge may cause problems in as many as one-third of patients requiring revision surgery following CWD mastoidectomy, which may be attributed to mucosalized surfaces, persistent cell tracts, or poorly ventilated areas ![]() The primary goal of surgical intervention for chronic ear disease is the development of a safe, dry, low-maintenance and hearing ear. In addition to bone pate´, other materials that have been described for mastoid obliteration include fat grafts, diced cartilage, fascia, bone chips, and ceramic materials such as hydroxyapatite. Palva further added the use of bone chips and bone pate´ in combination with a musculo periosteal flap. Palva went on to describe a modification of Popper’s flap as a musculo periosteal flap to obliterate the mastoid bowl. Popper described the use of a periosteal flap used to line, rather than obliterate the mastoid cavity. Kisch described the use of a pedicled temporalis muscle flap that was further expanded on by Rambo. Mosher originally used a superiorly based post auricular soft tissue flap. ![]() The concept of obliteration of the mastoid cavity was first introduced by Mosher in 1911 to promote healing of a mastoidectomy defect. ![]()
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