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Table 6
Recidivism and infection status after surgery
Surgical procedure Total (N) Recidivism N (%) Intermittent otorrhea N (%)
CWD tympano-mastoidectomy 43 4 (9,3 %) 18 (41,9 %)
CWU tympano-mastoidectomy 52 16 (30,8 %) 14 (26,9 %)
Aticotomy 2 1 (50%) 0
total number of relapses,15 (71.4%) underwent and the other with grade V House-Brackman
a second surgical procedure, on average 28 paralysis. Both required careful resection of
months after the first. the epidermoid tissue from the dehiscent
After statistical analysis we concluded that facial canal and placement of temporal fascia
recidivism was significantly dependent on the over the defect. The grade V patient slowly
type of mastoidectomy performed (p=0.02) improved facial function to a grade II after
and was significantly higher in the wall one year and a half of physiotherapy but in
up group compared to wall down (p=0.01). this case, a dead ear was seen after surgery,
Infection status of the cavity after surgery probably due to the advanced stage of the
was also analyzed, intermittent otorrhea was disease which had created a labyrinthine
most frequently seen in CWD patients 41,9 % fistula. The grade III case had a more rapid
compared to 26,9% of CWU, (p=0.125). improvement to a complete restoration of
Other postoperative complications included: function, within two months after surgery,
tympanic membrane perforation (n=23, while also benefiting from physiotherapy.
23,7%); dislocation/extrusion of prosthesis, At the time of the review of medical records
(n=6, 31,6% of all prosthesis placed); canal (chart 6), 16 patients (17% of total number
stenosis (n=1,1%), cophosis (n=1, 1%) and facial of patients) were discharged from ENT
nerve palsy (n=1, 1%). (table 7). In the single consulting with stable ears. In that group we
case of facial nerve palsy, a grade II House- registered an average follow-up period of 2.4
Brackmann paralysis was seen immediately years with 1 year as the minimum follow-up
after surgery and electromyography revealed required. Of those, 68% were from CWU group,
a neuropraxia lesion which had likely occurred 25% from CWD and 7% corresponded to
during unintentional manipulation of the aticotomies. On the other hand, we registered
facial nerve. The patient was treated with a a loss of follow-up due to unknown causes
small course of corticosteroids followed by in a relevant proportion of 27.7% of patients.
regular physiotherapy and slowly improved The remaining 55,3% of patients submitted to
to a complete resolution in 5 months. surgery during the 10-year timeframe covered
Nevertheless, two patients presented with by this study had maintained a regular follow-
facial nerve impairment preoperatively. up at the time of writing.
Among them one presented with grade III
Table 7
Postoperative complications
Reported events during follow-up N (%)
Tympanic membrane perforation 23 (23,7%)
Dislocation of the prosthesis 6 (31,6% of all prosthesis)
Canal stenosis 1 (1%)
Cophosis 1 (1%)
Facial nerve palsy 1 (1%)
168 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço
