TEES for Cholesteatoma
For this condition, the graft tissue, including the perichondrium and cartilage, was also harvested from the meatal surface of the tragus. Then, an elongated transmeatal incision was made to elevate the tympanomeatal flap. Next, the scutum was drilled to expose the attic area. The dissection was extended along the cholesteatoma to the bottom of the matrix until the cholesteatoma could be completely removed. If the ossicular chain was involved and destroyed by the cholesteatoma, ossiculoplasty was performed simultaneously as necessary. The reconstruction procedure was slightly modified according to the extent of the dissection in each case. In patients who had limited cholesteatomas confined within the attic, the tympanic cavity and scutum were reconstructed using the composite cartilage and perichondrium (close cavity procedure) (Figure 1) [20]. In patients who had advanced disease involving the mastoid cavity proper, we reconstructed only the tympanic cavity and left the mastoid antrum as an open cavity in the ear canal (open cavity procedure).
The performance of all of the above TEES procedures left no surgical wound outside the ear canal. After the operations, patients were regularly followed up in the outpatient clinic for 18 to 48 months. For patients who underwent tympanoplasty, successful surgery was defined as complete healing of the tympanic membrane; for those with cholesteatomas, it was defined as complete removal of the cholesteatoma without any residual or recurrent disease during the postoperative follow-up.