Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-19T04:59:34.005Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-term follow up after bony mastoid and epitympanic obliteration: radiological findings

Published online by Cambridge University Press:  24 September 2009

J-P Vercruysse ,
B De Foer ,
T Somers ,
J Casselman  and
E Offeciers
J-P Vercruysse*
Affiliation:
University Department of ENT, Augustinus Hospital, Antwerp, Belgium
B De Foer
Affiliation:
Department of Radiology, Augustinus Hospital, Antwerp, Belgium
T Somers
Affiliation:
University Department of ENT, Augustinus Hospital, Antwerp, Belgium
J Casselman
Affiliation:
Department of Radiology, Augustinus Hospital, Antwerp, Belgium Department of Radiology, AZ Sint-Jan AV Hospital, Bruges, Belgium
E Offeciers
Affiliation:
University Department of ENT, Augustinus Hospital, Antwerp, Belgium
*
Address for correspondence: Dr Jean-Philippe Vercruysse, University Department of ENT, St Augustine Hospital, Oosterveldlaan 24, 2610 Wilrijk, Antwerp, Belgium. Fax: 0032 3 443 36 11 E-mail: jphver@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The canal wall up bony obliteration technique lowers the incidence of recurrent cholesteatoma, but carries the potential risk of obliterating residual cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent cholesteatoma.

Patients:

Fifty-one patients presenting with a cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8–113.6 months).

Intervention:

All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging).

Results:

Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex cholesteatoma. On high resolution computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three cholesteatomas, and differentiated them from other associated soft tissues. No cholesteatoma was found within the obliterated mastoids.

Conclusion:

Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent cholesteatoma and to reconstruct unstable cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging succeeded in differentiating soft tissues, enabling detection of residual or recurrent cholesteatoma after a canal wall up bony obliteration technique procedure.

Keywords

CholesteatomaChronic OtitisMiddle EarMastoidObliterationDiffusion Magnetic Resonance ImagingNon-Echo Planar
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 1 , January 2010 , pp. 37 - 43
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Shelton, C, Sheehy, JL. Tympanoplasty: review of 400 staged cases. Laryngoscope 1990;100:679–81CrossRefGoogle ScholarPubMed
2 Offeciers, E, Vercruysse, JP, De Foer, B, Casselman, J, Somers, T. Mastoid and epitympanic obliteration. The obliteration technique. In: Ars, B, ed. Chronic Otitis Media. Pathogenesis Oriented Therapeutic Treatment. Amsterdam: Kugler, 2008;299–327Google Scholar
3 Vercruysse, JP, De Foer, B, Somers, T, Casselman, J, Offeciers, E. Pediatric bony mastoid and epitympanic obliteration. Otol Neurotol 2008;29:953–60CrossRefGoogle Scholar
4 Mercke, U. The cholesteatomatous ear one year after surgery with obliteration technique. Am J Otol 1987;8:534–6Google ScholarPubMed
5 Gantz, BJ, Wilkinson, EP, Hansen, MR. Canal wall reconstruction tympanomastoidectomy with mastoid obliteration. Laryngoscope 2005;115:1734–40CrossRefGoogle ScholarPubMed
6 Roberson, JB Jr, Mason, TP, Stidham, KR. Mastoid obliteration: autogenous cranial bone pâté reconstruction. Otol Neurotol 2003;24:132–40CrossRefGoogle ScholarPubMed
7 De Foer, B, Vercruysse, JP, Pouillon, M, Somers, T, Casselman, J, Offeciers, E. Value of high-resolution computed tomography and magnetic resonance imaging in the detection of residual cholesteatomas in primary bony obliterated mastoids. Am J Otolaryngol 2007;28:230–4CrossRefGoogle ScholarPubMed
8 Yung, MM, Karia, KR. Mastoid obliteration with hydroxyapatite – the value of high resolution CT scanning in detecting recurrent cholesteatoma. Clin Otolaryngol Allied Sci 1997;22:553–7CrossRefGoogle ScholarPubMed
9 De Foer, B, Vercruysse, JP, Pilet, B, Michiels, J, Vertriest, R, Pouillon, M et al. Single-shot, turbo spin-echo, diffusion-weighted imaging versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholesteatoma. AJNR Am J Neuroradiol 2006;27:1480–2Google ScholarPubMed
10 De Foer, B, Vercruysse, JP, Bernaerts, A, Maes, J, Deckers, F, Michiels, J et al. The value of single-shot turbo spin-echo diffusion-weighted MR imaging in the detection of middle ear cholesteatoma. Neuroradiology 2007;49:841–8CrossRefGoogle ScholarPubMed
11 De Foer, B, Vercruysse, JP, Bernaerts, A, Deckers, F, Michiels, J, Pouillon, M et al. Detection of postoperative residual cholesteatoma with non echo-planar diffusion-weighted magnetic resonance imaging. Otol Neurotol 2008;29:513–7CrossRefGoogle ScholarPubMed
12 Ayache, D, Williams, MT, Lejeune, D, Corré, A. Usefulness of delayed postcontrast magnetic resonance imaging in the detection of residual cholesteatoma after canal wall-up tympanoplasty. Laryngoscope 2005;115:607–10CrossRefGoogle ScholarPubMed
13 Vercruysse, JP, De Foer, B, Pouillon, M, Somers, T, Casselman, J, Offeciers, E. The value of diffusion-weighted MR imaging in the diagnosis of primary acquired and residual cholesteatoma: a surgical verified study of 100 patients. Eur Radiol 2006;16:1461–7CrossRefGoogle ScholarPubMed
14 Vercruysse, JPH, De Foer, B, Somers, TH, Casselman, J, Offeciers, E. MR of cholesteatoma: an update. B-ENT 2009, in pressGoogle Scholar
15 Hinohira, Y, Gyo, K, Yanagihara, N, Bredberg, G, Alsterborg, E. Effects of mastoid cavity obliteration on the growth of experimentally produced residual cholesteatoma. Acta Otolaryngol 1998;118:101–4Google ScholarPubMed