The Role of Total Transcanal Endoscopic Modified Radical Mastoidectomy in Extensive Mastoid Cholesteatoma: A Preliminary Report.

INTRODUCTION

Mastoid cholesteatoma is classically managed through a postauricular mastoidectomy approach. With the increasing use of endoscopic techniques in otologic surgery, various middle ear diseases can now be managed endoscopically. Modified radical mastoidectomy (MRM) still has a role in managing extensive mastoid cholesteatoma.

OBJECTIVES

To evaluate the feasibility of total transcanal endoscopic modified radical mastoidectomy (TTEMRM) for mastoid cholesteatoma at a single tertiary center.

METHODS

This 5-year retrospective review included 16 patients involving 17 operated ears with extensive cholesteatoma involving the middle ear and mastoid cavity, as demonstrated on preoperative high-resolution computed tomography of the temporal bone. All patients underwent TTEMRM under general anesthesia between January 2019 and December 2023.

RESULTS

Complete removal of mastoid cholesteatoma was achieved by lowering the posterior canal wall through the TTEMRM approach. Two cases developed delayed-onset facial nerve paresis, both of which resolved completely with conservative management. No evidence of recurrence was observed in all but 2 cases. Two cases required revision surgery through a postauricular mastoidectomy approach because of recurrent cholesteatoma. Four cases were lost to follow-up.

CONCLUSION

TTEMRM appears to be a useful technique for selected cases of extensive mastoid cholesteatoma requiring an open-cavity approach. Avoidance of an external incision and excellent visualization of the surgical field are among the advantages of this procedure.