Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-23T11:05:18.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Mastoid surgery and the Hong Kong Flap

Published online by Cambridge University Press:  29 June 2007

C. Andrew van Hasselt
C. Andrew van Hasselt*
Affiliation:
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
*
Professor of Surgery, Chief of Otorhinolaryngology, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Get access Rights & Permissions [Opens in a new window]

Abstract

Critical evaluation of the outcome of surgery for cholesteatoma has favoured open cavity techniques. These methods have however been plagued by an inability to consistently produce healthy well healed cavities.

The strength and stability of the normal tympanic membrane depends upon the separation of squamous epithelium from the middle ear mucosa by a fibrous tissue layer. Traditional methods of dealing with the cavity fail to reproduce a similar anatomically stable arrangement.

In order to achieve the highest percentage of dry, stable disease-free ears after employing basic surgical principles of wide access to facilitate meticulous removal of all cholesteatoma, we have utilized a vascularized deep temporalis fascia flap for complete coverage of the cavity eliminating all raw areas. This fibrous layer provides the optimal substrate for epithelial resurfacing. Excellent healing even under unfavourable circumstances is ensured by the rich blood supply to the pedicled temporalis fascia flap.

Considering patient preferences and cost effectiveness, the optimal treatment for cholesteatoma must be one operation, provided it achieves a dry safe ear. Based upon rational concepts, the ‘Hong Kong Flap’ technique of reconstructing the mastoid cavity involves a straightforward procedure requiring no special technical skill that consistently achieves this ideal.

Keywords

Mastoid, surgerySurgical flapsHong Kong
Type
Toynbee Memorial Lecture 1994
Information
The Journal of Laryngology & Otology , Volume 108 , Issue 10 , October 1994 , pp. 825 - 833
Copyright
Copyright © JLO (1984) Limited 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Delivered at The Royal Society of Medicine, 5 November 1993.

References

Abul-Hassan, H. S., von Drasek Ascher, G., Ackland, R. D. (1986) Surgical anatomy and blood supply of the fascial layers of the temporal region. Plastic and Reconstructive Surgery 77: 17–24.Google ScholarPubMed
Beales, P. H. (1959) The problem of the mastoid segment after tympanoplasty. Journal of Laryngology and Otology 73: 527–531.CrossRefGoogle ScholarPubMed
Beales, P. H., Hynes, W. (1958) Rapid healing after mastoid surgery by the use of the post-auricular flap. Journal of Laryngology and Otology 72: 888–901.CrossRefGoogle ScholarPubMed
Browning, G. C., Gatehouse, S., Swan, I. R. S. (1991) A new method of reporting the benefit from middle ear surgery. Laryngoscope 101: 180–185.CrossRefGoogle ScholarPubMed
Daggett, W. I. (1949) Treatment of chronic suppurative otitis media. Journal of Laryngology and Otology 63: 635–646.CrossRefGoogle ScholarPubMed
Guthrie, D. (1937) The Renaissance of Otology: Joseph Toynbee and his contemporaries. Journal of Laryngology and Otology 52: 163–176.CrossRefGoogle Scholar
Ho, J. H. C. (1978) An epidemiologic and clinical study of nasopharyngeal carcinoma. International Journal of Radiation Oncology, Biology, Physics 4: 181–198.CrossRefGoogle ScholarPubMed
Jenkins, G. J. (1925) Discussion on operative treatment of chronic middle ear suppuration. British Medical Journal 12: 1190–1112.Google Scholar
Mills, R. P. (1988) Surgical management of the discharging mastoid cavity. Journal of Laryngology and Otology 102: (suppl. 16).CrossRefGoogle Scholar
Palva, T. (1982) Obliteration of the mastoid cavity and reconstruction of the canal wall. In International Medical Reviews; Otolaryngology. Vol. 1 Otology. (Gibb, A. G., Smith, M. F. M.. eds.), Butterworths, London, pp 19–29.Google Scholar
Portmann, M. (1979). General Otological Principles in the Ear and Temporal Bone, Masson Publishing, USA, Inc., New York, pp 13–14.Google Scholar
Sade, J., Weinburg, J., Berco, E., Brown, M., Halvey, A. (1982) The marsupialized (radical) mastoid. Journal of Laryngology and Otology 96: 869–875.CrossRefGoogle ScholarPubMed
Sknner, D. W., van Hasselt, C. A. (1991) A study of the complications of grommet insertion for secretory otitis media in the presence of nasopharyngeal carcinoma. Clinical Otolaryngology 16: 480–482.CrossRefGoogle Scholar
Smyth, G. D. L. (1992) Toynbee Memorial Lecture 1992: Facts and fantasies in modern otology: the ear doctor's dilemma. Journal of Laryngology and Otology 106: 591–596.CrossRefGoogle ScholarPubMed
Smyth, G. D. L., Patterson, C. C. (1985) Results of middle ear reconstruction: do patients and surgeons agree? American Journal of Otology 6: 276–279.Google ScholarPubMed
Wilde, W. (1853). Practical Observations on Aural Surgery and the Nature and Treatment of Diseases of the Ear, Blanchard and Lea, Philadelphia, p 48.Google Scholar
Wormald, P. J., Alun-Jones, T. (1991) Anatomy of the temporalis fascia. Journal of Laryngology and Otology 105: 522–524.CrossRefGoogle ScholarPubMed