Attic Reconstruction After Cholesteatoma Surgery: Bone Versus Cartilage

Abstract

Cholesteatoma is a destructive, keratinizing epithelial lesion frequently associated with chronic suppurative otitis media (CSOM), leading to bone erosion and complications such as ossicular damage and labyrinthine fistula. Surgical intervention remains the definitive treatment, with goals centered on complete disease eradication, prevention of recurrence, restoration of hearing, and creation of a dry, self-cleansing cavity. Canal wall up (CWU) and canal wall down (CWD) techniques each have advantages and limitations, often influenced by anatomical and disease-related factors. Reconstruction of the attic wall plays a vital role in surgical success, particularly in cases involving epitympanic cholesteatoma. Materials for attic reconstruction commonly include autologous bone and cartilage, each offering distinct benefits. Cortical bone provides mechanical strength and reliable osseointegration but may be limited by donor site morbidity and risk of graft resorption. In contrast, cartilage is flexible, durable, and metabolically stable, promoting healing and epithelialization, though it lacks osteogenic properties and may mask residual disease.