The main advantage of this technique is to initiate the surgery from where the disease cholesteatoma has started, thus from the epitympanic membrane. Instead of removing a significant amount of cortical mastoid bone to reach to the disease, the surgeon by following the disease/retraction pocket/cholesteatoma will initiate the surgery from the external auditory canal. The bone removal is continued 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 can be continued to until the surgeon has 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 a good idea regarding the extent of the disease. The major advantage of the retrograde mastoidectomy is the ability of identification of tegmen and facial nerve in the middle ear at the beginning of the surgery. From this point the bone removal of mastoid and over the facial ridge can be done as much as needed. The mastoid cavity using this method will usually be smaller than the mastoidectomy. I also would like to point out the importance of using conchal (auricular) cartilage as mentioned by Dr. Dornhoffer's in his previous articles. Conchal cartilage has a nice curvature and is more flexible, if necessary larger pieces can 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 large perforation or retraction.