OTOLOGY Temporary removal of the posterior bony canal wall with reconstruction using microplate osteosynthesis in cholesteatoma surgery: a case series and description of the technique Karen Van der Gucht • Vincent Van Rompaey • Olivier Vanderveken • Paul Van de Heyning • Jos Claes Received: 6 April 2013 / Accepted: 10 June 2013 / Published online: 14 August 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract We describe the surgical technique of tempo- rary removal of the posterior auditory canal wall with reconstruction and report the outcome of using this tech- nique as a treatment method for cholesteatoma in a case series. In 32 cases of cholesteatoma surgery a technique of temporary removal of the posterior bony wall was applied. During primary surgery the posterior auditory canal wall was removed using an oscillating saw. For the purpose of reconstruction, the canal wall was repositioned and fixed using two titanium microplates (n = 26). In case the canal wall could not be reconstructed with osteosynthesis, either glass-ionomeric cement (BioCem TM ) was used for fixation (n = 4) or fibrin glue (Tissucol TM )(n = 2) to support the posterior wall. The outcome includes the healing process in the first postoperative month, the absence of residual or recurrent disease and the successful reconstruction of the posterior auditory canal wall as evaluated during second- look surgery. When microplates where used, we saw healing problems of the canal skin in about 4 % of patients. Recurrent cholesteatoma was found in 4 cases (14 %), residual cholesteatoma in 8 ears (25 %). In the osteosyn- thesis group, successful reconstruction was achieved in 25 patients (96 %). In 3 out of 4 patients of the glass- ionomeric cement group (75 %) excessive granulation tis- sue developed with extensive bony lysis. Temporary removal of the posterior auditory canal wall offers potential for the control of cholesteatoma. Our first results suggest that osteosynthesis allows for a good anatomical and functional reconstruction. Keywords Cholesteatoma Á Surgery Á Osteosynthesis Á Reconstruction Á External ear canal Introduction Posterior canal wall reconstruction has been described by several authors, either as part of a first stage or as a second procedure in cholesteatoma surgery [1–7]. This technique aims to avoid the negative sequelae of a radical mastoid cavity in canal wall down (CWD) procedures, and at the same time combines the advantages of both canal wall up (CWU) and CWD techniques [1, 8]. Most authors, how- ever, describe a technique with reconstruction of the canal wall with materials that differ from the original posterior wall [2–6, 9–11]. Only a few papers have reported on the temporary removal and immediate repositioning of the original bony canal wall in the same procedure [1, 7, 8]. At our institution we have developed a procedure for surgical management of cholesteatoma, in which the pos- terior bony canal is temporarily removed using an oscil- lating microsaw. After the completion of cholesteatoma resection, ossiculoplasty and myringoplasty, the original bony wall is repositioned. Microplate osteosynthesis per- mits repositioning of the posterior auditory canal wall with rigid internal fixation [1]. When the removed canal wall could not be reconstructed with microplate osteosynthesis, K. Van der Gucht (&) Á V. Van Rompaey Á O. Vanderveken Á P. Van de Heyning Á J. Claes Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium e-mail: karenvandergucht@hotmail.com J. Claes e-mail: jos_claes@uza.be K. Van der Gucht Á V. Van Rompaey Á O. Vanderveken Á P. Van de Heyning Á J. Claes Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium 123 Eur Arch Otorhinolaryngol (2014) 271:1497–1503 DOI 10.1007/s00405-013-2601-2