Tips and pitfalls of canal wall reconstruction in canal-wall-down mastoidectomy.
09-09, 15:30–16:00 (Europe/Istanbul), Otology 1

<p>The management of cholesteatoma relies primarily on surgical intervention, with canal-wall-up (CWU) and canal-wall-down (CWD) tympanomastoidectomy representing the main operative approaches. Despite meticulous removal, cholesteatoma remains associated with high rates of residual and recurrent disease. CWD procedures have been associated with reduced rates of recurrent disease, but the creation of a mastoidectomy cavity is fraught with the need of life-long ear debridement, regular office visits, and worse hearing outcome than CWU procedures. Two recent systematic reviews of mastoid obliteration case series reported 5‑year recurrence rates below 6%—a remarkable improvement compared with traditional non‑obliteration techniques. This course will review current literature on epitympanic and mastoid obliteration in the management of middle ear cholesteatoma, with focus on canal wall reconstruction in CWD mastoidectomy. The presenter will demonstrate his obliteration method in CWD mastoidectomy for reconstruction of the posterior canal wall to avoid a mastoidectomy cavity, highlighting key steps, potential pitfalls, postoperative imaging surveillance, and outcome data. The advantages and limitations of various obliteration materials—including autologous bone dust and active bioglass—will be discussed, along with indications for using temporoparietal fascia or periosteal flaps with axial blood supply to cover the filler material and promote optimal healing. The presentation will be enriched with intraoperative photographs and instructional videos.</p>
<p>Objectives:</p> <p>1-Describe the principles, indications, and surgical techniques of canal wall reconstruction in canal-wall-down (CWD) tympanomastoidectomy in the management of middle ear cholesteatoma.</p> <p>2-Identify the pitfalls, limitations, and patient’s selection for optimal postoperative healing and long-term outcomes.</p> <p>3-Compare patients self-reported quality of life measures before and after surgery.</p>
Session Chair Session Chair
Tayfun Kirazlı
Speaker Speaker
Simon I Angeli
Tayfun Kirazlı
<p>Past President Turkish orl hns society,2021-2023 , past president ent department of ege university, Otology and neurootology</p>
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Simon I Angeli
<p>I am a Professor of Clinical Otolaryngology, Director of the University of Miami Ear Institute, and Director of the ACGME-accredited Neurotology Fellowship Program. I hold two Board Certifications in Otolaryngology and Neurotology. Specific to this course, I am highly experienced in clinical and translational research in hearing loss and clinical research in genetic hearing loss. I am a cholesteatoma surgeon, have taught countless of surgical training courses both nationally and Internationally, and have carried out clinical studies on cholesteatoma outcomes in patients, both pediatric and adult subjects, from diverse backgrounds.</p>
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