A new method for reconstruction of the lateral wall of the attic after atticoanthrotomy

An original way for reconstruction lateral wall of the attic after separate atticoanthrotomy is proposed and demonstrated using a clinical case. Patient P. (33 years old) with chronic left-sided epitympanoantral suppurative otitis media. Left-sided mixed hearing loss of grade 3 (air-bone interval 50-55 dB). Under general anesthesia, a retroauricular approach to the tympanic cavity was performed, separate atticoanthrotomy was performed, pathological contents of the middle ear cavities were removed, and autofascia and autocartilage were harvested. According to the original technique, the cartilage plates were placed together and sutured with a 4-0 size absorbable braided polyglactin 910 suture using an atraumatic needle. The needle was first inserted through the center of both cartilage plates from front to back, withdrawn, and re-inserted near the previous needle entry point from back to front. The resulting loop was not tightened. Next, the cartilage was re-inserted from front to back near the previous needle entry point, forming a second loop through which the end of the suture without the needle was threaded. Both loops were then tightened. The suture was passed from the external auditory canal through the attic into the antrum and out into the external auditory canal. The sutured plates were placed in the attic so that their ends were adjacent to the posterior wall of the external auditory canal. The ends of the sutures were tightened with a trial knot so that the tension of the suture pressed the cartilaginous plates against the posterior wall of the external auditory canal. A mark was made where the knot touched the outer edge of the posterior bony wall of the external auditory canal, the knot was unraveled, a groove was made in the area of the mark, the ends of the suture were retightened, and a knot was tied in the groove. Ossicular chain reconstruction with a 2.25 mm partial prosthesis, tympanoplasty with fascia and cartilage, wound suturing, and packing of the external auditory canal were performed. After one year, the air-bone interval was 10 dB. Computed tomography of the temporal bones showed no recurrence of cholesteatoma, and reconstruction of the lateral wall of the attic was satisfactory. Conclusion. The development and implementation of new reconstructive techniques in chronic suppurative otitis media surgery expands the capabilities and enhances the physician’s skills. The proposed technique for forming the lateral attic wall after separate atticoanthrotomy effectively restores the anatomical relationship between the middle ear and the external auditory canal and has practical significance.