Pie-slice tympanoplasty for transcanal removal of small congenital cholesteatoma

ObjectiveTo describe a novel approach for removal of selected congenital cholesteatomas.MethodsDescription of technique and retrospective review of charts for patients undergoing procedure from January 1 to June 1, 2011. Two patients with congenital cholesteatomas localized to the middle ear necessitating transcanal surgical removal were identified. Using a transcanal approach, the “pie-slice” tympanic membrane flap was developed by incising the tympanic membrane anterior to the malleus, from the lateral process to the umbo. A second incision was then made anteriorly along an axis extending from the umbo to the 3-o’clock position for the right ear (9-o’clock in the left ear). The flap was elevated allowing for visualization and access to the lesion anterior to the malleus. The cholesteatoma was removed. Otoendoscopes were used to visualize the middle ear and ensure complete removal. The tympanic membrane was repaired with a tragal perichondrium graft placed medial to the edges of the elevated pie-slice flap. The flap was then replaced laterally.ResultsTympanic membranes are well healed in both patients after one year of follow-up with no evidence of disease and good hearing results.ConclusionPie-slice tympanoplasty is a simple and effective technique for removing selected localized congenital cholesteatomas and represents a novel approach to treating these entities that minimizes operative time and patient morbidity.