Reconstruction of the Posterior Canal Wall with Proplast

Many ears with prior radical or modified radical mastoidectomy operations can be rehabilitated by reconstruction of the posterior canal wall with the porous biocompatible implant material Proplast. Many techniques have been advanced for reconstruction of the posterior canal wall and/or obliteration of the mastoid bowl. We prefer reconstruction of the posterior canal wall to obliteration of the mastoid bowl on the theoretical grounds that with obliteration you lose the pneumatic buffer of the mastoid air cell system and you might be burying infection and/or cholesteatoma in the depths of the mastoid. In this article we shall present our results with elimination of the open mastoid bowl by reconstruction of the posterior canal wall with Proplast. A retrospective study of 83 consecutive patients who underwent reconstruction of the posterior canal wall with Proplast during the 5-year period 1974 to 1978 was undertaken. The surgical technique consisted of rebuilding the tympanic membrane, when necessary, repairing the ossicular chain, when necessary, and reconstructing the posterior canal wall. The overall success rate for the posterior canal wall reconstructions was 46% (38 of 83). However, after modifications were made in the technique, especially in the use of thicker fascia and/or perichondria and periosteum over the Proplast, the success rate increased dramatically to 68% (19 of 28).