![]() In the author’s opinion, after canal wall–down mastoidectomy for chronic ear disease, fatty tissue should only be used as one of the “fillers” in combined-graft obliteration techniques behind a new ear canal wall, reconstructed with soft tissue. The shrinkage of the fatty tissue starts soon after surgery, and postauricular retraction is visible within three months, and progresses over the first two years. g., removal of residual tumor, the amount of fatty and fibrous tissue was reduced to a quarter of its original volume. We have noticed that all patients undergoing surgery for acoustic neuromas who had the cavity obliterated with fat developed extensive retraction postauricularly, and at repeat surgery carried out for other reasons, e. c) Fatty tissue becomes fibrotic, and gradually shrinks. The following features of fatty tissue have been found to limit its use as an ideal obliteration material: a) Fatty tissue can only be used as a “filler”, b) Because of its consistency, it cannot be used in the reconstruction of the ear canal wall in the way that musculoperiosteal flaps can. The author has used abdominal fat in more than 650 patients after translabyrinthine removal of acoustic neuromas ( Tos and Thomsen 1991) and other skull base surgery procedures, but only very occasionally for obliteration of a cavity after a canal wall–down mastoidectomy. In myringoplasty, fat is sometimes used to close small perforations (Vol. Ringeberg and Fornato (1962) used fat for cavity obliteration in specific cases with an intakt posterior bony ear canal wall or intact ear canal skin. After radical mastoid surgery, Kadariu (1960) used fat for obliteration of the cavity. He suggested filling the retroauricular cavity with abdominal fat ( van Deinse and van den Borg 1958, Kuhweide and van Deinse 1960). In middle ear surgery, van Deinse proposed a method of extended antrotomy for inspection of the tympanic cavity, whilst partly preserving the posterior ear canal wall, as well as the bridge. 1958), and in translabyrinthine acoustic neuroma surgery, it has been used since the early 1960s by House ( House and Luetje 1979). ![]() In extensive petromastoid surgery for carcinoma of the middle ear, fat grafting has been used since the 1940s ( Penha 1951, Piquet et al. Fat is rarely used as an obliteration material in middle ear surgery, whereas in translabyrinthine acoustic neuroma surgery, fat is the only material used to obliterate the huge translabyrinthine cavity and prevent cerebrospinal fluid leakage.
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