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Reconstruction of tegmen defect by transmastoid approach

Presenting Author: Rie Kanai

Published online by Cambridge University Press:  03 June 2016

Rie Kanai  and
Shin-ichi Kanemaru
Rie Kanai
Affiliation:
Medical Research Institute, Kitano Hospital
Shin-ichi Kanemaru
Affiliation:
Medical Research Institute, Kitano Hospital
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Abstract

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Type
Abstracts
Information
The Journal of Laryngology & Otology , Volume 130 , Supplement S3: Abstracts for the 10th International Conference on Cholesteatoma , May 2016 , pp. S119
Copyright
Copyright © JLO (1984) Limited 2016 

Learning Objectives: To discuss about the procedure of reconstruction of tegmen defect by transmastoid approach to prevent meningo-encephalocele.

Objective: Tegmen defect is caused by progression of middle ear disease. Sometimes, meningo−encephalocele (MEC) occur into the middle ear through tegmen defect, which can cause serious complications: meningitis, cerebro spinal fluid (CSF) leakage, epilepsy. Hearing loss also can cause by MEC pressing ossicular chain. We discuss about the procedure of reconstruction of tegmen defect by transmastoid approach to prevent MEC.

Design: Retrospective study

Subjects and method: Seven cases (2 male 5 female, mean age 65.2) with large tegmen defect or with tegmen defect and CSF leakage were enrolled in this study. These patients underwent tympanomastoidectomy with reconstruction of the tegmen defects by transmastoid approach.

The kinds of diseases were cholesteatoma in 3 cases, cholesterol granuloma in 2 cases and MEC after previous middle ear surgery in 2 cases.

We analyzed the size of the defect, the materials for reconstruction and the complications; MEC, CSF leakage, the reccurence of the diseases.

Results: The size of defects were about 8 mm in 1 cases, more than 10 mm in 3cases and more than 20 mm in 3 cases. The tegmen defects were reconstructed by cortical bony plate with or without bone putty in all cases. In 2 cases, a part of dura was resected because lesion adhered to dura severely, then CSF leak occurred. We reconstructed also the dural defects by temporal fascia. In 2 cases with MEC, the lesion were resected by cauterization before the reconstruction of tegmen defect. We confirmed that bony tissue of tegmen was regenerated in all cases by postoperative CT scan. In 4 cases, they was confirmed during 2nd stage surgery. Although the recurrence of cholesteatoma was found distant from tegmen in one case, no patient have developed MEC, CSF leakage and other serous complication.

Conclusion: Tegmen defect can be reconstructed by transmastoid approach. Reconstruction of tegmen defect by cortical bone will be helpful to prevent MEC and CSF leakage.