Mastoidectomy reconstruction: management of the high facial ridge using hydroxylapatite implants.

A high facial ridge is a common feature of open cavity cases presenting for rehabilitation and was present in 25 percent of a series of 223 cases requiring such surgery. A precise scutumplasty and posterior wall repair is required for optimal results. Prior organic methods have been found to be time-consuming, difficult, or unreliable. Current wall prostheses are unsuited in shape to these limited defects. Reconstruction using semicircular porous hydroxylapatite ceramic attic defect plates, has proved simple and effective when combined with posterior wall repair using autograft cartilage or sheets of porous hydroxylapatite ceramic. Reconstruction results from this group were the best of the larger series. This was attributable to lesser preoperative pathology, precise scutum repair, and more reliable revascularization of the defect area. The last was partly owing to the smaller dimensions involved, but has been improved by enhanced blood supply from the use of the middle temporal flap.