Titanium in mastoid reconstruction

After cholesteatoma removal reconstruction of the canal wall is often necessary. There are several options. Autogenic tissue is first line, but cortical bone and the reimplantation of the posterior canal wall have doubtful results. Due to its bradytrophic nature cartilage has been used successfully in tympanoplasty and with its stability it is a well-established tissue for the reconstruction of the posterior wall. But adhesion forces in the diseased middle ear can cause retraction into the mastoid cavity. Amongst all different types of biomaterials titanium is one of the most accepted foreign materials. A titanium mesh can be formed into a “cage” to rebuild the mastoid and not only the posterior wall. This cage is covered with cartilage plates and chips. Nutritional support reaches the cartilage through the openings of the mesh. Wound healing and epithelialization are shown to be uneventful. The advantage of the cage over a pure canal reconstruction seems to be the anatomical restoration of the mastoid. Results show no exposure of the titanium construction, good epithelialization and acceptable functional results. Interestingly there is a notable risk of cholesteatoma recurrence in the former epitympanum at the typical place of cholesteatoma origin. In cases when major reconstruction is needed and an open cavity (radical cavity) is still not indicated, the mastoid reconstruction using a titanium cage is a good option in cholesteatoma surgery.