Introduction
The “Front-to-Back” approach to cholesteatoma surgery is widely
utilised. It minimises the destruction of disease free mastoid, allows
for early surgical identification of the integrity of ossicular chain
and other important anatomical structures. Despite these advantages, the
resulting canal wall defect presents a challenge to the surgeon. The
defect enlarges with extent of surgery from Atticotomy, to
Atticoantrostomy and Modified Radical Mastoidectomy; M2a, M2b and M2c in
the International Otology Outcomes Group consensus statement.[1] The
surgeon must decide upon the management of these defects
intraoperatively using their clinical acumen and knowledge of the
patient’s lifestyle and wishes. There are many different means by which
a mastoid cavity may be obliterated. There are a number of techniques
that have been utilized to facilitate this outcome: cartilage to
reconstruct the canal wall; bone chips harvested intraoperatively, a
variety of muscular flaps and synthetic substances to obliterate the
mastoid cavity. [2 3]
The morbidity to the patient of a mastoid cavity including dizziness on
exposure to cold air, being prone to more frequent infections, potential
lifelong attendance at outpatient departments, and the associated burden
to the service of providing such care, are far from insignificant. Thus
the benefits of obliterating the mastoid cavity are to both the patient
and the clinical service. In a recent study, obliteration of the mastoid
has been shown to reduce disease recurrence in children.[4]
S53P4BAG Bioactive Glass (BonAlive,(BonAlive Biomaterials Ltd., Turku,
Finland)) (Bioactive Glass), is a silica based biomaterial, composed of
Silicon Dioxide, Sodium Oxide, Calcium Oxide, and Phosphorous Pentoxide.
Bioactive glass has several properties that are advantageous in mastoid
obliteration as it is both osteoconductive (it provides a framework for
bone growth), and osteoproductive (it stimulates bone growth).[5] It
has also been demonstrated to have antibacterial properties against a
wide range of microorganisms.[6-8] There have been several studies
published relating to the safety, anatomical, functional and quality of
life relating to the use of bioactive glass. [9-11] However, there
is a sparsity of evidence relating to the clinical application of
bioactive glass, complications and their management. The aim of this
retrospective case review was to identify the techniques and outcomes
achieved when utilizing bioactive glass to obliterate the mastoid. Data
relating to these issues relates to consent, shared decision making with
our patients and intraoperative decision making.