Standard canal wall up (CWU) mastoid surgery leaves a mastoid defect of varying size, commonly covered by soft tissue. Rarely, this bony defect can cause discomfort, cosmetic issues or other problems. To mitigate these, the defect can be filled either at the initial or during a subsequent operation. Thomas and Gluth report their centre’s results using hydroxyapatite cranioplastic cement (HAC), which solidifies in minutes and is mouldable. Nineteen patients underwent primary reconstruction at the time of the index procedure and 10 underwent secondary reconstruction to correct unwanted issues (seven cosmetic concerns, five pain, three sharp defect edges, two autophony, one skin breakdown). Average follow-up was 10.1 months (0.48-48.4 months). Outcomes were favourable overall: one patient developed a delayed facial palsy several days after surgery, of presumed viral origin rather than related to surgery. It recovered to House-Brackmann grade two at 12 months. Apart from this, no complications arose: all patients had a good skull contour postoperatively, with no evidence of HAC resorption or extrusion, or surgical site infection. No worsening of pre-existing or development of new conductive hearing loss was observed on postoperative audiometry. All indications for secondary HAC reconstructions had resolved at the latest follow-up. All in all, HAC reconstruction of CWU defects appears safe in this case series.