Preservation of the bony canal in mastoid surgery recently has been called "intact canal wall mastoidectomy" or "intact canal wall tympanoplasty." The idea of preserving the bony canal in surgery for chronic middle ear and mastoid disease is old, but the trend to preserve the bony canal in the presence of a cholesteatoma is a new fad—and a disconcerting one to many of us "old-timers."
The surgical microscope certainly is the key to the revolutionary improvement in ear surgery, but more is being expected of it than is reasonable. It is a false sense of security to believe that with 10, 16, or 25 power one can see every squamous cell of a cholesteatoma matrix. Begley and Williams1 presented a microscopic section of an evagination in a cholesteatomatous matrix that required staining with hematoxylin and eosin and 285 power to be seen. Certainly then, with the limited power of
Closed vs Open Technique in Surgery of Aural Cholesteatomas. Arch Otolaryngol. 1967;86(4):361–362. doi:10.1001/archotol.1967.00760050363001
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