Modified after Palva

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Abstract
In Aalborg — during 20 months — 93 cases of simple and radical mastoidectomy have been done for acute and chronic otitis media. In the material the chronic cases dominate, especially the very chronic. Totally 43 simple and 50 radical mastoidectomies of varying radicality have been made, cholesteatoma was found in 31 cases (33%), fistula of the external canal in 11 cases (12%) and in 52 cases (56%) the ossicular chain was found interrupted most often by ostitic destruction of crus longum incudis. Great care has been made to remove ostitic bone as thoroughly as possible. In all but 3 cases a muscle obliteration of the cavity has been done. In 83 cases was used a retroauricular muscle flap a little modified after Palva's method. In 3 cases an anteriorly based flap from the temporal muscle and in 4 cases a combination of different muscle flaps were used. The material was evaluated 1–22 months after the operation. It is concluded that muscle obliteration of the cavity after Palva is an easy and technically attractive method in order to obtain a complete or partial obliteration of the cavity. The muscle flap is broadly based, always viable and little bleeding. In no case necrosis or pockets of infection have developed, and the postoperative reactions have been minimal. The simple mastoidectomies almost all have healed up quickly and neatly, and two thirds of the radical cavities have become dry and covered by epithelium. As a whole the methods has given fine results. However, the retroauricular muscle flap seldom will fill out more than half of the cavity. On the medial side of the flap granulation tissue often forms, delaying the final healing. A definite drawback with the method is its weakening of the cover of soft parts over the retroauricular, often very big cavity. Even if we have not had lasting retroauricular fistulae the thin cover has been suspicious in some cases.

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