Mastoid surgeries KK .ppt

Mastoid surgery is a commonly performed surgery by ENT surgeons. Although lots of modifications have been made in the techniques of mastoid surgery, the basic is cortical and modified radical mastoid surgery. In this lecture, I shall be discussing about different techniques of performing mastoid surgery, their advantages and disadvantages and complications of mastoid surgery.

1. Dr. Krishna Koirala //
Mastoid Surgeries

2. •Surgeryperformedonthemastoidtoremovediseasefromthemastoid
bone
Classification
A.Accordingtothestatusofbonycanalwall
−CanalWallup(bonycanalwalliskeptintact)
•Cortical
•CombinedApproachTympanoplasty(CAT)
−CanalWalldown(bonycanalwallisbrokendown)
•Atticotomy
•ModifiedRadical/Radicalmastoidectomy

3. B.Accordingtoextentofsofttissue/boneremoval
−CorticalMastoidectomy
−ModifiedRadical/Bondy’smastoidectomy
−RadicalMastoidectomy

4. •Tomakeearsafebyeliminatingcholesteatoma,
granulationsandchronicinfection
•Tomaketheearproblem-freeforallusual
activitiesofdailyliving,includingswimming
•Torestoreorimprovehearingwheneverpossible
•Toprovideanacceptablecosmeticappearance

5. •Approaches to Mastoid Surgeries
–End aural (Lempert’s)
–Postaural (Wilde’s)
–Extended Endaural
–Circumferential

6. •Advantages
−NormalappearanceofEAC
−Hearingaidseasilyfit
−Noroutinecleaningrequired
−Hightoleranceforwaterexposure
•Disadvantages
−Usuallyastagedprocedure
−Relativelyhighrateofrecurrentorpersistent
cholesteatomas

7. •Advantages
−Usuallyasingleprocedure
−Lowrateofpersistentorrecurrentcholesteatomas
•Disadvantages
−Enlargedexternalauditorymeatus
−Hearingaidsdifficulttofit
−Periodiccanalcleaningneeded
−Occasionalproblemwithwaterexposure

8. •Synonyms
−Schwartz's operation
−Simple mastoidectomy
−Complete mastoidectomy

9. −Completeexenteretionofallaccessiblemastoidair
cellsandconvertthemintoasinglecavity
−Posteriorcanalwallandmiddleearstructureskept
intact

10. •Incompletely resolved ASOM with reservoir sign
•CSOM TT not responding to conservative medical treatment
•Acute coalescent mastoiditis
•Masked Mastoiditis
•Approach to
−Endolymphatic sac surgery
−Facial nerve decompression
−CP angle tumors (Translabyrinthine approach)
−Cochlear implant surgery

11. •Wilde’sPostauricularincision
•Dissectionofsofttissuesandpreparationofgraft
•Elevationofperiostium
•IdentificationofMCEwan'striangle
•ExposureofMastoidantrum
•Exenteratingofallaccessiblemastoidaircells
•Placementofgraft
•Placementofdrain
•Closureofwoundandmastoiddressing

12. Post auricular incision

15. •Superior:Dural plate
•Inferior: Digastric ridge
•Anterior: Posterior wall
of external auditory canal
•Posterior: Sigmoid sinus
plate
•Medially: Dome of
Lateral semicircular canal

16. •Anoperationperformedtoeradicatediseasefromthe
middleearcavityandmastoid,inwhichthemastoidand
epitympanicspacesareconvertedintoaneasilyaccessible
commoncavitybyremovingtheposteriorandsuperior
externalbonycanalwallswithpreservationofthehealthy
ossiclesandTMremnant

17. •Aim
−Eradicatediseasefromthemiddleearcleftin
ordertomaketheearsafeanddryandto
preserveorimprovehearing
•Indications
–CSOMAAwithadequatecochlearfunction
(serviceablehearing)

18. •Allaccessiblediseasedmastoidaircellsalongwith
cholesteatomaandgranulationsareremoved
•Bonyposteriorcanalwallislowered
•Diseasefromthemiddleearcavityisremovedbutnormal
mucosaofmiddleear,remnantTMandhealthyossiclesare
preserved
•MastoidcavityandEACbecomeasinglecavityseparatedby
middleearcavity

19. Perform
Tympanoplasty and concho
-meatoplasty
Preserve
healthy mucosa, T.M.
remnant and ossicles
Remove
cholesteatoma and
granulations from mastoid
air cells & middle ear cavity
Lower
facial ridge and break facial
bridge
Performcortical mastoidectomy

20. A large, adequate meatoplasty is necessary to create a
problem-free cavity

21. •Aims
−Remove/eradicatediseasefromthe
middleearcleft
−Maketheearsafeanddry
−Noattemptmadetopreservehearing

22. 1. CSOM atticoantral disease with
−Profound sensorineural hearing loss
−Intra-cranial complication
−Recurrence after modified radical mastoidectomy
2. Limited malignancy of middle ear
3. Glomus jugulare
4. Osteomyelitis of temporal bone

23. −Allaccessiblediseasedmastoidaircellsalongwith
cholesteatomaandgranulationsareremoved
−Bonyposteriorcanalwallislowereddown
−Diseasefromthemiddleearcavityalongwiththemucosa
ofmiddleear,remnantTMandossiclesexceptthestapes
footplateareremoved
−Eustachiantubeopeningisclosedandmastoidcavity,EAC
andmiddleearcavityallareconvertedtoasinglecavity

24. •Performcorticalmastoidectomy
•Lowerfacialridge&breakfacialbridge,
removecholesteatoma&granulations
frommastoidaircells&middleear
•Remove remnant middle ear mucosa,
T.M. remnant & ossicles (except stapes
footplate)
•CloseEustachiantubeopeningand
performConcho-meatoplasty
•Mastoid,E.A.C.&middleearbecome
singlecavity

25. •Injury to dural plate leading t bleeding, CSF leak and brain
fungus
•Injury to the sigmoid sinus leading to bleeding
•Injury to facial nerve leading to complete or incomplete facial
palsy
•Injury to the stapes footplate leading to sensorineural hearing
loss/ dead ear
•Incomplete surgery leading to residual disese
•Mastoid cavity problems in including discharging mastoid cavity

26. 1.Inadequateconcho-meatoplasty
2.Recurrenceofcholesteatoma
3.Residualcholesteatomain:Facialridge,sinoduralangle,
mastoidtip,sinustympani,anteriorEpitympanum
4.Persistentinfection:Petrositis,T.B.,sinusitis
5. Persistent allergy
6. Retained foreign body :cotton ball
7. Wrong indication

27. Mastoid cavity problems can be reduced by
•Complete removal of disease
•Saucerization of cavity
•Adequate lowering of facial ridge
•Round cavity
•Wide conchomeatoplasty
•Grafting the tympanic membrane

28. •Advantages
−Fasterhealing
−Easier long-term
postoperativecare
−No waterprecautions
necessary (particularly
importantinchildrenand
watersports)
−Moreoptionsavailablefor
hearingaid,ifnecessary
•Disadvantages
−Epitympanum/mastoidnot
accessibletopostoperative
inspection
−Supratubalspacenoteasily
accessibleunlessmalleushead
andincusremoved
−Bothresidualandrecurrent
diseasemorelikely
−Greaternumberofprocedures
requiredfordiseaseeradication

29. •CorticalMastoidectomy
•AnteriorTympanotomyvia
tympano-meatalflap
•Posteriortympanotomyvia
facialrecess
•Tympanoplasty