Comparison of mastoid obliteration with middle temporal artery flap versus open cavity: a comparative study


  • Himanshu Swami Department of ENT, Command Hospital Air Force, Bangalore, Karnataka, India
  • A. P. Arjun Department of ENT, Command Hospital Air Force, Bangalore, Karnataka, India
  • Sweekritha N. Bhat Department of ENT, Command Hospital Air Force, Bangalore, Karnataka, India



Middle temporal artery, Flap, Mastoid obliteration, Reconstruction, Open cavity, Canal wall down, Mastoidectomy, Cholesteatoma, Squamosal


Background: The objective was to study the outcomes of the canal wall down (CWD) mastoidectomy patients in those with soft canal wall reconstruction by using middle temporal artery (MTA) flap in comparison to those with cavity left open.

Methods: A prospective study of 20 patients undergoing CWD surgery was done with 10 in each group of mastoid obliteration and open cavity. The outcomes were studied at 1, 3, 6 and 12 months post-surgery.  

Results: At the final assessment of 12 months post op, the obliteration group had only 10% patients with grade 1 infection while open cavity group had 40% with grade 2 infection. Obliteration of mastoid cavity and reconstruction of canal wall with soft tissue MTA flap gave excellent control of infection.

Conclusions: The MTA flap is highly flexible and versatile for otologic reconstruction with an excellent arc of rotation and robust blood supply. It does not have the issues of resorption, dehiscence or fistula formation faced in other obliteration techniques.


Bento RF, De Oliveria ACF. Brief history of mastoidectomy. Int Arch Otorhinolaryngol. 2013;17(2):168-78.

Harkness P, Brown P, Fowler S, Grant H, Ryan R, Topham J. Mastoidectomy audit. Results of the Royal College of Surgeons of England comparative audit of ENT surgery. Clin Otolaryngol Allied Sci. 1995;20(1):89–94.

Mosher HP. A method of filling the excavated mastoid with a flap from the back of the auricle. Laryngoscope. 1911;21(12):1158-63.

Chan CY, Chan YM. Mastoid obliteration and reconstruction – a review of techniques and results. Proceedings of Singapore healthcare. 2012;21(1):23-9.

Black B. Mastoidectomy elimination. Laryngoscope. 1995;105(12):1-30.

Smith PG, Stroud MH, Goebel JA. Soft-wall reconstruction of the posterior external ear canal wall. Otolaryngol Head Neck Surg. 1986;94(3):355-9.

Linthicum FH. The fate of mastoid obliteration tissue: a histopathological study. Laryngoscope. 2002;112:1777-81.

Black B, Kelly S. Mastoidectomy reconstruction: revascularizing the canal wall repair. Am J Otol. 1994;15:91–5.

Darei P, Mattox DE. Landmarks for the preservation of MTA during mastoid surgery - Cadaveric dissection study. Am J Otolaryngol Head Neck Med Surg. 2018;39(1):6-9.

Merchant SN, Wang P, Jang CH, Glynn RJ, Rauch SD, McKenna MJ, et al. Efficacy of tympanomastoid surgery for control of infection in active ottis media. Laryngoscope. 1997;107(7):872-7.

Fagan PA, Rodrigues SJ. Middle temporal artery flap in mastoid surgery. Otol Neurotol. 2004;25:242-4.

Singh V, Atlas M. Obliteration of persistently discharging mastoid cavity using middle temporal artery flap. Otolaryngol Head Neck Surg. 2007;137:433-8.

Saunders JE, Shoemaker DL, McElveen JT. Reconstruction of the radical mastoid. Am J Otol. 1992;13(5):465-9.

Gantz BJ, Wilkinson EP, Hansen MR. Canal wall reconstruction tympanomastoidectomy with mastoid obliteration. Laryngoscope. 2005;115(10):1734-40.

Charachon R, LeJeune JM, Bouchal H. Reconstruction of radical mastoidectomy by obliteration technique. Ear Nose Throat J. 1991;70(12):830-8.

Minatogawa T, Machizuka H, Kumoi T. Evaluation of mastoid obliteration surgery. Am J Otol. 1995;16(1):99-103.

Mahendran S, Yung MW. Mastoid obliteration with hydroxyapatite cement: The Ipswich experience. Otol Neurotol. 2004;25:19-21.

Rosenblunt B, Ahlvin RC, Carr CD. Silicone implants in the mastoid portion of the temporal bone. Ann Otol Rhino Laryngol. 1996;75:889-92.

Reck R, Storkel S, Meyer A. Bioactive glass ceramics in middle ear surgery. Ann N Y Acad Sci. 1988;523:100-6.

Renard JL, Felten D, Bequet D. Post otoneuro surgery aluminium encephalopathy. Lancet. 1994;2:63-4.






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