Grafting Versus No Grafting in Canal Wall Down Mastoidectomy, Data-Based Study

Abstract

Background: Canal wall down (CWD) mastoidectomy is a well-established surgical approach for cholesteatoma eradication; however, it frequently creates problematic open mastoid cavities requiring prolonged postoperative care and limiting patients' quality of life. The clinical benefit of adjunctive grafting remains controversial.
Aim: To compare the value of adding grafting to canal wall-down mastoidectomy and evaluate the associated operative and postoperative results, involving operative time, operative complications, and postoperative complications.
Patients and Methods: This retrospective, data-based comparative research comprised 100 adult patients who underwent CWD mastoidectomy for acquired cholesteatoma between 2019 and 2025 at two Egyptian tertiary centers. Cases have been separated into grafting (number=50) and non-grafting (number=50) groups. Operative time, intraoperative complications, cavity healing, and patient satisfaction were assessed and compared.
Results: The grafting group demonstrated significantly superior early outcomes, including dry ear at 1 month (74% vs. 0%) and 3 months (100% vs. 10%), complete epithelialization (100% vs. 0%), and dry healthy cavity at follow-up (84% vs. 0%) (all P<0.001). Cases satisfaction scores at six months were significantly higher with grafting (4.76±0.59 vs. 3.32±0.70, P<0.001). The non-grafting group had significantly shorter operative time (109.38±20.53 vs. 130.78±17.47 minutes, P<0.001). Non-significant variances have been found in hemorrhage during the operation or facial nerve exposure.
Conclusion: Grafting during CWD mastoidectomy provides significantly superior cavity healing, fewer postoperative complications, and higher patient satisfaction despite longer operative time, supporting its role as a valuable surgical adjunct.