The main advantage of this system is to initiate the surgery from where the disease cholesteatoma

 has started, thus from the epitympanic membrane. rather than removing a big amount of cortical mastoidal to achieve to the disease, the surgeon by following the disease/retraction pocket/cholesteatoma will initiate the surgery from the external auditory meatus. The bone removal is sustained parallel to lateral process of malleus and following the disease. Once both anterior epitympanic recess and superior ligament is clearly identified, bone removal toward incudomalleal articulation will be continued to until the surgeon contains a clear view of tegmen and later short process of incus. I usually use a smaller coarse diamond on lower speed until the attictomy phase is completed. At this very phase of surgery, the surgeon will have an honest idea regarding the extent of the disease. the most important advantage of the retrograde mastoidectomy is that the ability of identification of tegmen and facial within the cavum at the start of the surgery. From this time the bone removal of mastoid and over the facial ridge are often done the maximum amount pro re nata. The mastoid cavity using this method will usually be smaller than the mastoidectomy. I also would love to indicate the importance of using conchal (auricular) cartilage as mentioned by Dr. Dornhoffer's in his previous articles. Conchal cartilage features a nice curvature and is more flexible, if necessary larger pieces may be removed. The scaring and deformity after harvesting conchal cartilage is minimal unless excessive tissue is harvested. I usually use the conchal cartilage to partially obliterate mastoid bowl or for grafting the big perforation or retraction. A Canal Wall down Mastoidectomy is an efficient technique for eradication of advanced Chronic otitis or Cholesteatoma. Thus, we aimed to seek out out the incidence and factors causing cavity problems after Canal wall down mastoidectomy.