Mastoid Obliteration and Canal Wall Reconstruction with Posterior Auricular Artery (PAA) Flap

ENT clinical case: mastoid obliteration and canal wall reconstruction with posterior auricular artery (PAA) flap.

First of all, a full cleanse of the mastoid cavity is needed, regularizing bony ridges and irregularities. In cases of intraoperative cholesteatoma finding it was also fully removed. All signs of epithelium must be removed in order to avoid cholesteatoma development. Middle ear assessment is made, ossicular chain (OC) status was checked. In the case of a mobile footplate, ossicular chain reconstruction (OCR) was made:

(1) with an intact stapes suprastructure, OCR was made with a polyethylene PORP;

(2) In case of an absent suprastructure, a hydroxyapatite TORP was utilized for OCR. The tympanic membrane was reconstructed with a full-thickness (from tragus or conchae) cartilage. The mastoid cavity was then obliterated with bone pate and the PAA fascia-periosteum flap, fixated with fibrin glue sealant. OCR, tympanic membrane, and flap placement were done with the utilization of endoscopes due to enhanced visualization and precision. PAA flap placement should be over the facial ridge and the distal portion of the flap is used also for tympanic membrane reconstruction.