Objectives: To investigate the importance of the integrity and pattern of the
periosteal lining of the mastoid cavity in the outcome and sequel of the different
types of the mastoid surgeries.
Methods:
Revision mastoid surgeries (122 cases) of different kinds (both
canal
wall-up and canal wall-down mastoidectomies) between the years
2010
and 2015 were included. Intra-operative multiple curettages from the
unhealthy-looking
bone in direct relation to pathologic findings as granulations,
polypi, and cholesteatoma were collected and histopathologically
studied
to determine the nature of the bony tissue and the status of the periosteum.
Preoperative computed tomography (CT) scans for both revision
and
primary surgery for every case were evaluated whenever possible.
Results:
In all cases, periosteal problems could be detected. Periosteal
layer
deficiency in 1 or more areas of the mastoid cavity was present in almost
all cases, and it was always replaced by granulation tissue or unhealthy
bony tissue. Periostitis was suspected in 23 cases (18%), whereas
osteitis
of different levels of severities was suspected in 69 cases (57%).
Sclerotic
and diploic cellularity types of mastoid were mostly affected. In addition,
when the primary surgery was performed in cellular mastoid, these
pathologic
findings were very minimal.
Conclusions:
Healthy integral periosteal lining of the mastoid cavity seems
to be an essential factor for the cavity stability and surgery outcome. Detailed
understanding of the mastoid cavity development, anatomy, and histology
together with the studying of the preoperative CT scans helps in preserving
the integrity of the cavity periosteum during surgery.