Atlas of Cavityless Cholesteatoma Surgery: Volume I and Volume II

Review by L Flood
Middlesborough, UK

It was puzzling to me that this large format book could run to two volumes when covering what is, after all, fairly well established practice in cholesteatoma surgery. Otologists are constantly told that an open cavity is to be deplored, and various measures have long evolved to avoid this. We have seen intact canal wall surgery with posterior tympanotomy, however controversial that remains, decades on. We can also obliterate a cavity with bone, pedicled flaps and synthetic materials, or we can even recreate the posterior canal wall. The hope then was these two volumes would add some novelty, or, failing that, at least be a useful instructional tool for historically conventional practice.

Alas, anything claiming to be an atlas must first be judged on the quality of what are indeed profuse coloured illustrations. The back cover describes these as ‘hundreds of high definition operative photographs in each chapter’. I am afraid I found them very disappointing and desperately in need of the processing that is now fundamental to digital imaging. The majority are very dark indeed, the red is oversaturated and the white balance is never corrected; the result is that many are totally indecipherable. There are exceptions, and Volume II is better than Volume I. Figures 11.13– 11.19 are of the quality to be expected, but I defy anyone to make sense of Figures 1.187–9 or 1.126. Obsolete 35 mm slides are easily digitised and can then be transformed with modern software. There is no lack of images here, but few are up to contemporary standards.

There is then the text, but I struggled to find novelty here. The title suggested some individual philosophical approach to cholesteatoma, but that was never apparent. Indeed, one must read up to page 157 before encountering a chapter entitled ‘Cavityless Canal Wall Down Mastoidectomy’. Curiously, Volume I closes with a chapter on ossiculoplasty, which does have some decent operative photographs and diagrams, but nowhere does the otoendoscope put in an appearance.

Volume II provides conventional coverage of cholesteatoma management, with any consideration of a cavity or not as an incidental. There are therefore chapters on revision surgery, facial palsy or labyrinthine fistula, with a ‘how we do it’ approach to the discussion. As the text moves on, to the more serious complications of cholesteatoma, we do (sensibly enough) see increasing recognition of the desirability of a residual cavity, despite the title.

In conclusion, this title is curiously inappropriate. Avoidance of a cavity is widespread practice now and is certainly not the emphasis, and the books really do struggle to provide a quality atlas. Any personal computer now has the image processing software that could have transformed this publication, but I truly regret that I really cannot recommend it in its current format.

Amazon Link: Atlas of Cavityless Cholesteatoma Surgery: Volume I and Atlas of Cavityless Cholesteatoma Surgery: Volume II
By purchasing books via this link you will help to fund the JLO