Purpose: To explore the outcomes of lateral attic wall (LAW) reconstruction using autogenous mastoid cortical bone in cases with poorly developed zygomatic root cells and/or a low tegmen or with significant anterior or lateral sigmoid sinus in tympanomastoid surgery. Material and methods: Thirty-five ears with chronic suppurative otitis media, all of them either with poorly developed zygomatic root cells and/or a low tegmen (26/35 ears), or with significant anterior or lateral sigmoid sinus (9/35 ears), were included. LAWs were removed temporarily to offer exposure of the attic; after removal of the pathological conditions in the attic and the mastoid, LAW was reconstructed using autogenous mastoid cortical bone. The condition of the reconstructed LAW and tympanomastoid aeration was evaluated by computed tomographic scan or/and otoendoscopy. Results: The pathological conditions in the attic, the antrum, and the mastoid could be removed with safety in all cases; no serious complications occurred, the new canal appeared to be of normal size and shape, and no dislocation or necrosis of the repaired part was noted. Most of the cases had no significant attic retraction and kept good tympanomastoid aeration postoperatively. Conclusion: The reconstruction of LAW is especially suited to the cases in our study, and the reconstructed LAW can produce an almost normal anatomical external auditory canal, prevent the formation of attic retraction, and restore the mastoid cavity aeration in most of the cases. (C) 2011 Elsevier Inc. All rights reserved.