Endoscopic Transcanal Mastoidotomy with Posterior Half-Shield Cartilage Tympanoplasty

By June 6, 2019

Tolisano, Anthony M1; Isaacson, Brandon1
1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Endoscopic middle ear surgery is well established, but disease extension into the mastoid is still most often managed with the microscope and a postauricular incision. In the case of a sclerotic mastoid and anterior sigmoid sinus, this potentially requires a canal wall down or Bondy mastoidectomy to perform safely. This video seeks to demonstrate the feasibility and operative technique for an entirely transcanal endoscopic approach for removal of cholesteatoma that extends into the mastoid cavity proper.

A single transcanal endoscopic case video demonstrating the above procedure.

Our approach to cholesteatoma removal in the case of a sclerotic mastoid with an anterior sigmoid sinus includes the use of the endoscope for the removal of the cholesteatoma within the mastoid cavity. This minimally invasive approach allows for the surgeon to maintain an entirely transcanal approach. This video highlights the pertinent steps of an example case and provides surgical pearls, such as how to drill with the endoscope, cholesteatoma dissection, and reconstruction of the defect. Preoperative CT-imaging and postoperative clinical exam findings are provided, as well.

An entirely transcanal endoscopic approach to cholesteatoma extending into the mastoid cavity proper is feasible and precludes the need to perform a more invasive canal wall down or Bondy mastoidectomy approach.