Cholesteatoma surgery in pneumatized and non-pneumatized temporal bones.

BACKGROUND This report compares the different surgical methods for large and pneumatized mastoid cavity (large cavity) and small and poorly pneumatized mastoid cavity (small cavity) cholesteatomas and their results for the facial nerve and mastoid cavity. METHODS In the period from January 1996 to December 2000, 101 ears with cholesteatomas underwent tympanoplasty with mastoidectomy. In the large cavity group, the posterior canal wall was removed and the vertical portion of the facial nerve was skeletonized to lower the facial ridge. Partial obliteration with conchal cartilage and perichondrium at the epitympanum and mastoid tip was used to make the external auditory canal and the mastoid a smooth common cavity without reconstruction of the posterior canal wall. In the small cavity group, the facial ridge was not intentionally lowered as long as the cholesteatoma was completely removed. The whole mastoid cavity was obliterated and the posterior canal wall was reconstructed. The newly reconstructed posterior canal wall was composed of preserved facial ridge in the lower part and obliterated conchal cartilage in the upper part. RESULTS There were 27 ears with large cavity cholesteatomas and 74 with small cavity cholesteatomas. The incidences of postoperative complications (large cavity versus small cavity) were: facial paralysis, 3 versus 0; minor wound infection, 2 versus 8; flap partial necrosis, 1 versus 4; cartilage partial necrosis, 0 versus 2; external auditory canal stenosis, 0 versus 2; residual drum perforation, 3 versus 3; otitis media with effusion, 3 versus 4; recurrent cholesteatoma, 0 versus 2; and residual cholesteatoma, 1 versus 2. CONCLUSION Significantly more postoperative facial nerve paralysis in the large cavity group was correlated to skeletonization of the facial nerve and treatment of the facial ridge.