Four layers reconstruction of the posterior ear canal wall in one stage surgery


  • Khaled M. Mokbel Khalefa Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt



Mastoidectomy, Cholesteatoma, Cartilage graft, Perichondrium, Periosteum


Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative otitis media with cholesteatoma to ensure complete disease removal. The resulting cavity is prone to recurrent infection, chronic discharge and frequent care. Reconstruction of the posterior canal wall should be planned by the surgeon. Various techniques for external auditory canal (EAC) reconstruction have been recommended to eliminate open cavity problems. The surgeon should choose the type of grafts either autologous, homografts or synthetic materials. Furthermore, the surgeon should decide whether to do the reconstruction either immediate in the first stage of surgery or delayed as a second stage.

Methods: In this study, the ridge was reconstructed at the same time of mastoidectomy by autologous tissues. The presenting study reconstructed the posterior canal wall in four layers; skin, perichondrial flap, cartilage and periosteal flap in that order from the meatal side to the mastoid side. The presenting study included 48 patients (32 males and 16 females) with age ranged from 18-55 and 20-50 years. All included patients were presented at the outpatient clinic with unilateral chronic suppurative otitis media with persistent discharge. They had been operated at our tertiary hospital between January. 2012 to March 2014.

Results: Successful reconstruction was obtained in all cases, with no dehiscence or necrosis.

Conclusions: The reconstruction of the posterior wall by the four layers technique was successful and efficient. It is recommended to do this repair concomitantly with canal wall down mastoidectomy as one stage surgery.

Author Biography

Khaled M. Mokbel Khalefa, Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt

Department of OtoRhinoLaryngology Mansoura University Hospital Mansoura University


Santina CCD, Lee SC. Ceravital reconstruction of canal wall down mastoidectomy: long-term results. Arch Otolaryngol Head Neck Surg. 2006;132(6):617-23.

Whittemore KR, Merchant SN, Rosowski JJ. Acoustic mechanisms: canal wall-up versus canal wall down mastoidectomy. Otolaryngol Head Neck Surg. 1998;118(6):751-76.

Fischer JL, Nesbitt NB, Littlefield PD. Bone plate obliteration in canal wall down mastoidectomy: : modifications of an established technique. Otol Neurotol. 2020;41(3):352-8.

Roche P, Coolahan I, Glynn F, McConn WR. Autologous bone pate in middle ear and mastoid reconstruction. Rev Laryngol Otol Rhinol (Bord). 2011;132(4-5):193-6.

Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope. 1997;107(8):1094-9.

Shea JJ, Makenbaum BT, Moretz W. Reconstruction of posterior canal wall with proplast. Otolaryngol Head Neck Surg. 1984;92(3):329-33.

Uçar C. Canal wall reconstruction and mastoid obliteration with composite multi-fractured osteoperiosteal flap. Eur Arch Otorhinolaryngol. 2006;263(12):1082-6.

Ramsey MJ, Merchant SN, McKenna MJ. Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall down tympanomastoidectomy. Otol Neurotol. 2004;25(6):873-8.

McCleve, Don MD. Repair of bony canal wall defects in tympanomastoid surgery. Am J Otol. 1985;6(1):76-9.

Black B, Kelly S. Mastoidectomy reconstruction: revascularizing the canal wall repair. Am J Otol. 1994:15(1):91-5.

Palva T. Cholesteatoma surgery today. Clinic Otolaryngol Allied Sci. 1993;18(4):245-52.

Zini C, Quaranta N, Piazza F. Posterior canal wall reconstruction with titanium micro-mesh and bone pate. Laryngoscope, 2002;112(4):753-6.

Walker PC, Mowry SE, Hansen MR, Gantz BJ. Long-term results of canal wall reconstruction tympanomastoidectomy, Otology Neurotol. 2014;35(6):954-60.

Magnan J, Chays A, Pencroffi E, Locatelli P, Bruzzo M. Canal wall prosthesis-new devices. Rev Laryngol Otol Rhinol (Bord). 1995;116(1):19-21.

Duckert LG, Makielski KH, Helms J. Refined mastoid reconstruction with the pedicled postauricular perichondrial flap. Am J Otol. 1997;18(1):10-4.






Original Research Articles