The chronically infected open mastoidectomy cavity is a common problem in otologc surgery. Corrective surgical options include revision surgery, obliteration with flaps or fillers, ablation (canal closure) or external canal wall (EAC) reconstruction. The latter is preferred, to facilitate reinspection for residual disease, if necessary.

Canal wall repairs require reconstruction of a stable and durable, precisely shaped and fitted support layer, healthy overlying skin and a vascular intermediate layer to nourish the skin and protect the support layer.

This presentation demonstrates the use of titanium sheeting in this role, in conjuction with the middle temporal flap, whiach has been the basis for optimal long term success.

The surgery employs six phases;

1. Transcanal flap creation and clearance of disease from the stapes and its surrounds.

2. Postaural incision and creation of the middle temporal flap.

3. Clearance of cavity disease, retaining skin flaps for the EAC repairs. Creation of zygomatic root and facial ridge retention grooves. Shaping and sizing the titanium sheeting, using an aluminium foil template.

5.Reconstruction of the hearing and canal wall components.

6. EAC packing and wound closure.

Titanium sheeting has proven a highly effective canal wall repair method with no complications in a series of 35 cases, but mesh was less effective and is not recommended. Second stage surgery is recommended when the cavity lining is fragile, and residual disease possible.