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The risk of recurrent cholesteatoma after radical mastoidectomy reduction with alloplastic osteoconductive bone replacement material
18 April 2018 (online)
Radical cavity reduction leads to faster wound healing and increases patient comfort in terms of ear care, follow-up visits and vestibular function. The reduction process is commonly carried out with the use of corporeal material, such as bone meal, ear cartilage and muscle flaps.
In case of previously well-pneumatized radical cavities and after preliminary surgical procedures corporeal material may be inadequate.
An alternative in such cases is the use of bone replacement material “BonAlive”. One possible downfall for the use of this material is the difficult detection of recurring cholesteatomas.
42 radical mastoidectomies have been successfully reduced at our clinic since 2010 with this material.
In all 42 cases the reduction was adequate and successful, with no reports of material rejection, infections or intolerance reactions. All patients reported a reduction in secretion or complete normalization and were satisfied with the outcome. A second look operation was performed on 17 patients. In all cases, there were no complications in the processing of the scar-like material. The use of the Soundbridge was easily possible in several patients. There was no recurrent cholesteatomas during follow ups or performed second look operations.
Overall, the use of “BonAlive” for the reduction of very large radical cavities is a useful and successful option. Although there were no proven risks of cholesteatoma formation behind the material. The use of the Vibrant Soundbridge after radical cavity reduction with BonAlive is also recommendable, even when implantation criteria are fulfilled.