Removal of scutum & obliteration of aditus to treat cholesteatoma limited to attic
Canalwall up mastoidectomy
Uses facial recess approach
Removal of mastoid air cells, lateral mastoid cortex, and Körner septum
Surgically created cavity ("mastoid bowl") communicates with epitympanum & antrum
Simple cortical mastoidectomy
Similar to canal wall up mastoidectomy; however, epitympanum and antrum not entered
Ossicles not visualized
Translabyrinthine approach to internal auditory canal (IAC)
Canal wall up mastoidectomy + semicircular canals removed, facial nerve canal skeletonized, sigmoid plate and posterior IAC removed
Open cavity procedures remove posterior EAC wall & scutum
Canal wall down mastoidectomy
Similar to canal wall up + removal of posterior EAC wall and scutum
1 large cavity: EAC, mastoid, mastoid antrum, epitympanum, and mesotympanum
± obliteration of middle ear orifice of eustachian tube with fascia or fat, to prevent exposure of surgical cavity to nasopharynx
± filling of "mastoid bowl" with fat
± reconstruction of EAC using thin sheet of hydroxyapatite
Termed modified radical mastoidectomy when ossicular chain is preserved
Termed radical mastoidectomy for treatment of holotympanic disease: Skeletonization of mastoid segment facial nerve canal and diseased ossicles
Open-close procedures remove and then replace/reconstruct posterior EAC wall
Recent literature suggests mastoidectomy approach with posterior canal wall reconstruction and obliteration of mastoid cavity (MAPRO)
To avoid disadvantages of both canal wall up and canal wall down mastoidectomy
Rectosigmoid approach to IAC
Suboccipital craniotomy ± bone flap over craniotomy defect
+ resection of posterior wall of IAC
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Kronenberg J et al: Mastoidectomy reconstruction of the posterior wall and obliteration (MAPRO): preliminary results. Acta Otolaryngol. 132(4):400-3, 2012
Yamashita K et al: Detection of middle ear cholesteatoma by diffusion-weighted MR imaging: multishot echo-planar imaging compared with single-shot echo-planar imaging. AJNR Am J Neuroradiol. 32(10):1915-8, 2011
Cimsit NC et al: Diffusion-weighted MR imaging in postoperative follow-up: reliability for detection of recurrent cholesteatoma. Eur J Radiol. 74(1):121-3, 2010
De Foer B et al: Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging--value in detection. Radiology. 255(3):866-72, 2010
Plouin-Gaudon I et al: Diffusion-weighted MR imaging for evaluation of pediatric recurrent cholesteatomas. Int J Pediatr Otorhinolaryngol. 74(1):22-6, 2010
Rajan GP et al: Preliminary outcomes of cholesteatoma screening in children using non-echo-planar diffusion-weighted magnetic resonance imaging. Int J Pediatr Otorhinolaryngol. 74(3):297-301, 2010
Schwartz KM et al: Diffusion-weighted imaging for cholesteatoma evaluation. Ear Nose Throat J. 89(4):E14-9, 2010
Lehmann P et al: 3T MR imaging of postoperative recurrent middle ear cholesteatomas: value of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 30(2):423-7, 2009
Thiriat S et al: Apparent diffusion coefficient values of middle ear cholesteatoma differ from abscess and cholesteatoma admixed infection. AJNR Am J Neuroradiol. 30(6):1123-6, 2009
Trijolet JP et al: [Acute mastoiditis in children: can mastoidectomy be avoided?.] Ann Otolaryngol Chir Cervicofac. 126(4):169-74, 2009
Venail F et al: Comparison of echo-planar diffusion-weighted imaging and delayed postcontrast T1-weighted MR imaging for the detection of residual cholesteatoma. AJNR Am J Neuroradiol. 29(7):1363-8, 2008
De Foer B et al: Single-shot, turbo spin-echo, diffusion-weighted imaging versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholesteatoma. AJNR Am J Neuroradiol. 27(7):1480-2, 2006
Dubrulle F et al: Diffusion-weighted MR imaging sequence in the detection of postoperative recurrent cholesteatoma. Radiology. 238(2):604-10, 2006
Aikele P et al: Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. AJR Am J Roentgenol. 181(1):261-5, 2003
Kösling S et al: CT and MR imaging after middle ear surgery. Eur J Radiol. 40(2):113-8, 2001
Castillo M et al: Imaging of Bezold's abscess. AJR Am J Roentgenol. 171(6):1491-5, 1998
Mukherji SK et al: CT of the temporal bone: findings after mastoidectomy, ossicular reconstruction, and cochlear implantation. AJR Am J Roentgenol. 163(6):1467-71, 1994
Related Anatomy
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References
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Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Diagnostic Checklist
TERMINOLOGY
Definitions
Mastoid procedure to remove diseased tissue (inflammatory or neoplastic) & preserve normal structures
Removal of scutum & obliteration of aditus to treat cholesteatoma limited to attic
Canalwall up mastoidectomy
Uses facial recess approach
Removal of mastoid air cells, lateral mastoid cortex, and Körner septum
Surgically created cavity ("mastoid bowl") communicates with epitympanum & antrum
Simple cortical mastoidectomy
Similar to canal wall up mastoidectomy; however, epitympanum and antrum not entered
Ossicles not visualized
Translabyrinthine approach to internal auditory canal (IAC)
Canal wall up mastoidectomy + semicircular canals removed, facial nerve canal skeletonized, sigmoid plate and posterior IAC removed
Open cavity procedures remove posterior EAC wall & scutum
Canal wall down mastoidectomy
Similar to canal wall up + removal of posterior EAC wall and scutum
1 large cavity: EAC, mastoid, mastoid antrum, epitympanum, and mesotympanum
± obliteration of middle ear orifice of eustachian tube with fascia or fat, to prevent exposure of surgical cavity to nasopharynx
± filling of "mastoid bowl" with fat
± reconstruction of EAC using thin sheet of hydroxyapatite
Termed modified radical mastoidectomy when ossicular chain is preserved
Termed radical mastoidectomy for treatment of holotympanic disease: Skeletonization of mastoid segment facial nerve canal and diseased ossicles
Open-close procedures remove and then replace/reconstruct posterior EAC wall
Recent literature suggests mastoidectomy approach with posterior canal wall reconstruction and obliteration of mastoid cavity (MAPRO)
To avoid disadvantages of both canal wall up and canal wall down mastoidectomy
Rectosigmoid approach to IAC
Suboccipital craniotomy ± bone flap over craniotomy defect
+ resection of posterior wall of IAC
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Kronenberg J et al: Mastoidectomy reconstruction of the posterior wall and obliteration (MAPRO): preliminary results. Acta Otolaryngol. 132(4):400-3, 2012
Yamashita K et al: Detection of middle ear cholesteatoma by diffusion-weighted MR imaging: multishot echo-planar imaging compared with single-shot echo-planar imaging. AJNR Am J Neuroradiol. 32(10):1915-8, 2011
Cimsit NC et al: Diffusion-weighted MR imaging in postoperative follow-up: reliability for detection of recurrent cholesteatoma. Eur J Radiol. 74(1):121-3, 2010
De Foer B et al: Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging--value in detection. Radiology. 255(3):866-72, 2010
Plouin-Gaudon I et al: Diffusion-weighted MR imaging for evaluation of pediatric recurrent cholesteatomas. Int J Pediatr Otorhinolaryngol. 74(1):22-6, 2010
Rajan GP et al: Preliminary outcomes of cholesteatoma screening in children using non-echo-planar diffusion-weighted magnetic resonance imaging. Int J Pediatr Otorhinolaryngol. 74(3):297-301, 2010
Schwartz KM et al: Diffusion-weighted imaging for cholesteatoma evaluation. Ear Nose Throat J. 89(4):E14-9, 2010
Lehmann P et al: 3T MR imaging of postoperative recurrent middle ear cholesteatomas: value of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 30(2):423-7, 2009
Thiriat S et al: Apparent diffusion coefficient values of middle ear cholesteatoma differ from abscess and cholesteatoma admixed infection. AJNR Am J Neuroradiol. 30(6):1123-6, 2009
Trijolet JP et al: [Acute mastoiditis in children: can mastoidectomy be avoided?.] Ann Otolaryngol Chir Cervicofac. 126(4):169-74, 2009
Venail F et al: Comparison of echo-planar diffusion-weighted imaging and delayed postcontrast T1-weighted MR imaging for the detection of residual cholesteatoma. AJNR Am J Neuroradiol. 29(7):1363-8, 2008
De Foer B et al: Single-shot, turbo spin-echo, diffusion-weighted imaging versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholesteatoma. AJNR Am J Neuroradiol. 27(7):1480-2, 2006
Dubrulle F et al: Diffusion-weighted MR imaging sequence in the detection of postoperative recurrent cholesteatoma. Radiology. 238(2):604-10, 2006
Aikele P et al: Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. AJR Am J Roentgenol. 181(1):261-5, 2003
Kösling S et al: CT and MR imaging after middle ear surgery. Eur J Radiol. 40(2):113-8, 2001
Castillo M et al: Imaging of Bezold's abscess. AJR Am J Roentgenol. 171(6):1491-5, 1998
Mukherji SK et al: CT of the temporal bone: findings after mastoidectomy, ossicular reconstruction, and cochlear implantation. AJR Am J Roentgenol. 163(6):1467-71, 1994
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