Learning Objectives: To learn how to do scutumplasty for intact canal wall tympanoplasty and atticotomy/antrotomy in the video session

Introduction: Postoperative retraction of the ear drum sometimes occurs after cortical mastoidectomy or atticotomy for attic cholesteatoma. One of the most important points to protect retraction is to firmly reconstruct the scutum with a sliced cartilage.

Surgical procedures: After the tympanomeatal flap is elevated anteriorly beyond the scutum, choleateatoma matrix was removed with canal wall up method or attictomy. Concha cartilage was thinned by 0.5 mm or less with a cartilage slicer. The most important point for the scutumplasty is to firmly pile up a thinly sliced cartilage on the anterior bony edge of the scutum bone defect. When a cartilage size is not enough to cover the posterior bony edge, a piece of cartilage is added to cover the posterior site. The inferior edge of the cartilage is placed on the malleus neck.

Subjects and Methods: Between 2006 and 2011, 138 ears with primary acquired cholesteatoma were operated on with atticotomy/scutumplasty (28 ears), canal wall up method (87 ears), and canal wall down and reconstruction (23 ears). One-stage operation was 49 ears and two-stage operation was 89 ears. The mean follow-up time was 44.1 months (9–100 months).

Results: Postoperative recurrence due to the ear drum retraction was 17.0% using Kaplan-Meier analysis. Successful hearing outcomes (A-B gap 20 dB or less) was 83/124 (66.9%) according to the AAO-HNS criteria in 1995.

Conclusion: To reconstruct the scutum bone defect firmly is a key point to succeed canal wall up method and atticotomy for attic cholesteatoma. At the presentation, surgical videos and slides will be presented.