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.