Objective: To estimate whether leaving a high facial ridge (FR) during canal wall down (CWD) tympanoplasty increases the risk of residual cholesteatoma. Methods: Retrospective case review. Patients treated with a primary CWD tympanoplasty for middle ear cholesteatoma were divided into a completely lowered FR group (CLFR) and a non-completely lowered FR (NLFR) group. Factors affecting FR management, residual rate, and disease-free survivals were analyzed. Results: 321 patients were included. Residual rates were 10.8% in the NLFR and 16.6% in the CLFR (p=0.15). Localization at sinus tympani, mesotympanum, supratubal recess, preoperative extracranial complication, and destroyed ossicular chain or fixed platina were associated with CLFR. Residual rates and disease-free survival did not significantly differ between groups. Conclusions: Facial ridge can be managed according to cholesteatoma extension. The FR can be maintained high if the cholesteatoma does not involve sinus tympani, mesotympanum or supratubal recess, without increasing the risk of residual disease.
