Reconstruction of mastoidectomy defect with titanium mesh

Objective - Intact-canal-wall mastoidectomy procedures leave an unsightly depression in the postauricular area. Until now, there have been few reports of successful reconstruction of mastoidectomy defects, and none using titanium mesh. When secondary mastoidectomy is not anticipated, as in endolymphatic sac shunt procedures, the postauricular defect resulting from mastoidectomy can be eliminated by reconstruction using titanium mesh. This is a retrospective study of 14 patients who underwent reconstruction of a mastoidectomy defect with titanium mesh. Material and Methods - All 14 patients underwent mastoidectomy as part of endolymphatic sac shunt procedures for Ménière's disease. All of the patients had mastoid bones free of chronic infection or cholesteatoma. At the time of mastoidectomy, a large piece of cortical bone was removed and saved instead of being drilled away. After the main procedure was completed, and before closing the postauricular skin, a piece of 1.3-mm titanium mesh was cut to cover the mastoidectomy defect. The mesh was then attached to the mastoid bone at the four corners using 4- or 6-mm screws. The piece of cortical bone removed at the beginning of the mastoidectomy was attached under the mesh and across the mastoid defect. Patients were followed for a period of 6 months to 3 years. The outcome was considered successful when there was no depression at the mastoidectomy site and no evidence of any infection. Results - All patients who underwent reconstruction of a mastoidectomy defect with titanium mesh maintained a normal contour of the mastoid bone without depression or infection. There were no failures. Conclusions - Mastoidectomy defect reconstruction with titanium mesh is a reliable method for preventing an unsightly depression at the mastoidectomy site. This method is ideal when repeat mastoidectomy is not expected.