Canal wall up mastoidectomy is a surgical procedure that involves completely removing the diseased air cells and tissues lateral to the otic capsule while preserving the bony ear canal wall. It is often performed along with tympanoplasty and ossicular chain reconstruction to treat chronic otitis media or mastoiditis. The document outlines the history, anatomy, indications, techniques and complications of canal wall up mastoidectomy.
1. Mastoidectomy is a surgical procedure that opens the mastoid cavity to clean infected air cells and improve ventilation. It has evolved from simple trephination for acute infection to modern techniques like intact canal wall mastoidectomy.
2. The temporal bone contains the mastoid, squamous, tympanic and petrous parts. Important surgical anatomy includes the mastoid antrum, facial recess, and relationships to surrounding structures like the sigmoid sinus and dura.
3. Mastoidectomies are classified based on whether the posterior ear canal wall is preserved (intact canal wall) or removed (canal wall down). Common types include cortical, radical, modified radical, atticotomy
This document provides information on canal wall down (CWD) mastoidectomy surgery. It defines CWD mastoidectomy as the removal of the posterior and superior bony walls of the external ear canal and excision of all mastoid air cells, converting the mastoid cavity, middle ear, and ear canal into a single cavity exteriorized through the ear canal. It discusses indications for CWD mastoidectomy such as cholesteatoma, tumors, and anatomical factors like a low-lying tegmen. The document outlines the surgical technique and considerations like facial ridge lowering. It also addresses outcomes, complications, and the challenges of long-term management after CWD mastoidectomy.
The document discusses the mucosal folds of the middle ear, which develop as the primitive tympanic cavity expands into the middle ear cleft between 3-7 months of fetal development. This forms four primary sacs that enlarge and replace the mesenchyme, with their walls becoming the mucosal lining of the middle ear. Mucosal folds are the planes of contact between neighboring sacs and carry ligaments and blood vessels to the ossicles. There are 10 important mucosal folds described, including the anterior and posterior malleal folds, lateral malleal ligamental fold, and tensor tympani fold. The folds divide the epitympanum (attic) and orient the progression of
1. Inverted papilloma is a benign epithelial tumor originating from the Schneiderian membrane of the nasal cavity and paranasal sinuses.
2. It most commonly affects males ages 30-50 and presents as a unilateral nasal mass, obstruction, and bleeding.
3. Treatment involves surgical resection, typically an endoscopic medial maxillectomy to remove the entire lateral nasal wall and clear the tumor attachment site.
Cholesteatoma etiology, theories, clinical features and managementDivya Raana
Cholesteatoma is a sac of keratinizing skin in the middle ear that can erode bone. It is usually acquired after ear infections cause retraction pockets. On imaging, it appears as soft tissue with bone erosion. Treatment involves surgical removal via modified radical mastoidectomy to eliminate the disease and create a self-cleaning ear. The surgery follows the cholesteatoma from back to front to fully remove it while preserving hearing if possible.
This document provides information about different types of mastoidectomy procedures. It begins with a brief history of mastoidectomy surgery dating back to 1873. It then discusses indications for various procedures like cortical mastoidectomy, canal wall up (CWU) mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy. Key anatomical structures are defined. Surgical techniques for CWU mastoidectomy are outlined, including incision, periosteal elevation, and middle ear dissection steps. Contraindications and debates around CWU versus canal wall down approaches are also summarized.
This document discusses atticotomy, a surgical procedure for treating attic cholesteatoma. Atticotomy involves removing the scutum bone to access and remove limited attic disease, then reconstructing the scutal defect to prevent recurrence. It is indicated for small, localized attic cholesteatomas. The risks of the procedure include facial nerve injury, hearing loss, and infection. Post-operative follow up is needed to monitor for complications like residual disease.
Total laryngectomy involves removal of the entire larynx. It has historically been performed since 1866, with improvements over time such as the two-stage procedure developed by Gluck to reduce mortality rates. Today it is generally reserved for advanced laryngeal cancers with extensive spread. The procedure involves mobilizing neck structures like the strap muscles and thyroid gland, dissecting and removing the larynx, and closing the resulting pharyngeal defect. Complications can include issues with the skin flap, pharyngocutaneous fistula, tracheal stenosis, and endocrine abnormalities.
1. Mastoidectomy is a surgical procedure that opens the mastoid cavity to clean infected air cells and improve ventilation. It has evolved from simple trephination for acute infection to modern techniques like intact canal wall mastoidectomy.
2. The temporal bone contains the mastoid, squamous, tympanic and petrous parts. Important surgical anatomy includes the mastoid antrum, facial recess, and relationships to surrounding structures like the sigmoid sinus and dura.
3. Mastoidectomies are classified based on whether the posterior ear canal wall is preserved (intact canal wall) or removed (canal wall down). Common types include cortical, radical, modified radical, atticotomy
This document provides information on canal wall down (CWD) mastoidectomy surgery. It defines CWD mastoidectomy as the removal of the posterior and superior bony walls of the external ear canal and excision of all mastoid air cells, converting the mastoid cavity, middle ear, and ear canal into a single cavity exteriorized through the ear canal. It discusses indications for CWD mastoidectomy such as cholesteatoma, tumors, and anatomical factors like a low-lying tegmen. The document outlines the surgical technique and considerations like facial ridge lowering. It also addresses outcomes, complications, and the challenges of long-term management after CWD mastoidectomy.
The document discusses the mucosal folds of the middle ear, which develop as the primitive tympanic cavity expands into the middle ear cleft between 3-7 months of fetal development. This forms four primary sacs that enlarge and replace the mesenchyme, with their walls becoming the mucosal lining of the middle ear. Mucosal folds are the planes of contact between neighboring sacs and carry ligaments and blood vessels to the ossicles. There are 10 important mucosal folds described, including the anterior and posterior malleal folds, lateral malleal ligamental fold, and tensor tympani fold. The folds divide the epitympanum (attic) and orient the progression of
1. Inverted papilloma is a benign epithelial tumor originating from the Schneiderian membrane of the nasal cavity and paranasal sinuses.
2. It most commonly affects males ages 30-50 and presents as a unilateral nasal mass, obstruction, and bleeding.
3. Treatment involves surgical resection, typically an endoscopic medial maxillectomy to remove the entire lateral nasal wall and clear the tumor attachment site.
Cholesteatoma etiology, theories, clinical features and managementDivya Raana
Cholesteatoma is a sac of keratinizing skin in the middle ear that can erode bone. It is usually acquired after ear infections cause retraction pockets. On imaging, it appears as soft tissue with bone erosion. Treatment involves surgical removal via modified radical mastoidectomy to eliminate the disease and create a self-cleaning ear. The surgery follows the cholesteatoma from back to front to fully remove it while preserving hearing if possible.
This document provides information about different types of mastoidectomy procedures. It begins with a brief history of mastoidectomy surgery dating back to 1873. It then discusses indications for various procedures like cortical mastoidectomy, canal wall up (CWU) mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy. Key anatomical structures are defined. Surgical techniques for CWU mastoidectomy are outlined, including incision, periosteal elevation, and middle ear dissection steps. Contraindications and debates around CWU versus canal wall down approaches are also summarized.
This document discusses atticotomy, a surgical procedure for treating attic cholesteatoma. Atticotomy involves removing the scutum bone to access and remove limited attic disease, then reconstructing the scutal defect to prevent recurrence. It is indicated for small, localized attic cholesteatomas. The risks of the procedure include facial nerve injury, hearing loss, and infection. Post-operative follow up is needed to monitor for complications like residual disease.
Total laryngectomy involves removal of the entire larynx. It has historically been performed since 1866, with improvements over time such as the two-stage procedure developed by Gluck to reduce mortality rates. Today it is generally reserved for advanced laryngeal cancers with extensive spread. The procedure involves mobilizing neck structures like the strap muscles and thyroid gland, dissecting and removing the larynx, and closing the resulting pharyngeal defect. Complications can include issues with the skin flap, pharyngocutaneous fistula, tracheal stenosis, and endocrine abnormalities.
Cholesteatoma is defined as a cystic bag-like structure filled with desquamated squamous debris lying on a fibrous matrix, also known as "skin in the wrong place." It can be congenital or acquired. Acquired cholesteatomas are either primary, with unknown etiology, or secondary caused by acute necrotizing otitis media. Evaluation involves history, examination, audiometry and CT scan to determine extent. Surgical treatment aims to eradicate the cholesteatoma while preserving hearing, with options like canal wall up or down mastoidectomy depending on the case. Complications can include infection, bone destruction, hearing loss and facial nerve paralysis if
1. A cholesteatoma is a cyst-like sac in the middle ear that is lined with keratinizing squamous epithelium and contains desquamated keratin. It is not a tumor and does not contain cholesterol.
2. Cholesteatomas can be congenital, arising from embryonic cell rests, or acquired through retraction pockets, squamous metaplasia, or migration of epithelium through a perforated eardrum.
3. It expands through bone erosion using enzymes produced by the epithelial lining and inflammatory cells, and can cause hearing loss, facial paralysis, and other complications if left untreated.
1. Mastoidectomy is a surgical procedure that opens the mastoid cavity to clean infected air cells and improve ventilation. It has evolved from simple trephination for acute infections to modern techniques that preserve normal anatomy.
2. The document outlines the history, surgical anatomy, types (cortical, radical, modified radical), indications, and techniques of mastoidectomy. Types are classified as open (canal wall down) or closed (canal wall up) approaches.
3. Potential complications are discussed briefly. Controversies remain regarding the best surgical techniques and approaches to different pathologies.
1. The document discusses the embryology and anatomy of the frontal sinus and frontal recess. It develops from ethmoidal cells that pneumatize into the frontal bone.
2. It describes different surgical approaches to access and drain the frontal sinus including external approaches and various types of endoscopic frontal sinusotomies.
3. Type 1 and 2 endoscopic procedures involve draining the frontal sinus via the frontal recess and removing obstructions. Type 3 is a more extensive procedure that creates a common chamber between the frontal sinus and nasal cavity via an intranasal modified Lothrop procedure.
Cholesteatoma is a cystic lesion formed from keratinizing stratified squamous epithelium in the temporal bone. It has a complex pathogenesis involving both congenital and acquired factors. Congenitally, it may arise from epithelial rests or microperforations. Acquired cholesteatomas develop primarily from invagination or secondarily from implantation, migration, or basal cell changes. Molecularly, cytokines released in response to bacteria promote bone erosion and development of cholesteatoma.
Mastoidectomy is a surgical procedure to access and treat infections of the mastoid air cells behind the ear. Over time, the procedure has evolved from simple cortical mastoidectomies described in the 17th century to more advanced techniques using an operating microscope and drill. Modern mastoidectomies are typically classified as canal wall up or canal wall down depending on whether the bony ear canal wall is preserved. Indications include treatment of cholesteatoma, refractory ear infections, and approaches for other inner ear procedures. The surgery involves an incision behind the ear to access and clean out the infected mastoid air cells.
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
The nasal valve is the narrowest part of the nasal passage located between the septum and upper lateral cartilages. Problems in this area can be due to weak or resected cartilage, or secondary to issues like septal deviations or turbinate hypertrophy. Diagnosis involves visual inspection and using probes to check for collapse or improvement from distraction. Treatment aims to restore normal anatomy and support the nasal framework using techniques like septoplasty, spreader grafts, onlay grafts, and valve suspension to correct primary or secondary valve abnormalities.
This document discusses cholesteatoma, including definitions, classifications, theories of pathogenesis for congenital and acquired types, and management approaches. Cholesteatoma is an abnormal skin growth in the middle ear that can cause bone destruction. It is classified as congenital or acquired primary/secondary. Management involves surgical removal, with the goal of total eradication, to obtain a safe, dry ear. Canal wall down and canal wall up procedures are described. Complications include hearing loss, facial nerve issues, and rare but serious intracranial infections.
The document discusses the anatomy of the sinus tympani, a cavity located in the posterior region of the tympanic cavity. It describes how the sinus tympani was first named and discussed in 1820. It defines the two portions of the retrotympanum based on the position of the facial nerve. It outlines different shapes that the sinus tympani can take, including classical, confluent, partitioned, and restricted, and different types - A, B, and C - based on its extension in relation to the facial nerve. The shapes and types of the sinus tympani can influence the surgical approach used for cholesteatoma surgery.
1. Mastoidectomy is a surgical procedure that opens the mastoid cavity to clean infected air cells and improve ventilation. It has evolved from simple trephination for acute infection to current canal wall preserving techniques.
2. There are several types of mastoidectomy including cortical, radical, modified radical, tympanomastoidectomy, and mastoidectomy with intact canal wall. The procedure performed depends on the extent and location of disease.
3. Key anatomical structures of the mastoid include the mastoid antrum, facial recess, and the relationship between the mastoid and middle/inner ear. Careful identification of these structures is important for safe mastoid surgery.
This document provides an overview of the steps involved in primary sinus surgery via an endoscopic approach. It begins with a brief history of sinus surgery and then discusses preoperative assessment, including CT scans to evaluate sinus anatomy and disease patterns. The basic techniques of Messerklinger and Wigand are described. The key steps of the surgery are then outlined in detail, including uncinectomy, antrostomy of the maxillary sinus, anterior and posterior ethmoidectomy, sphenoid sinusotomy, and frontal sinusotomy when necessary. Throughout, anatomical landmarks and variations are discussed to guide safe dissection and avoid complications.
This document provides an overview of laryngeal framework surgery techniques. It discusses the anatomy of the laryngeal cartilages and muscles involved in voice production. It then describes the history and types of thyroplasty procedures developed to improve voice, including type 1-4 thyroplasties. Type 1 involves medialization of the vocal fold while types 2-4 are used to expand, relax or increase tension on the vocal folds. Other techniques discussed include arytenoid adduction, thyroarytenoid myomectomy, cricothyroid approximation and femlar surgery. Complications and limitations of the procedures are also summarized.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Glomus tumours are benign, slow-growing, hypervascular tumours that originate from glomus bodies in the middle ear. They are most commonly seen in the 5th decade of life and affect females more often than males. On histology, they appear as clusters of cells arranged in a nested pattern surrounded by a vascular stroma. Surgical excision is the primary treatment, though pre-operative embolization of feeding vessels can help reduce blood loss. Glomus tumours can spread locally within the temporal bone and occasionally metastasize to distant sites like the lungs. Advanced cases may require a combined surgical and radiotherapy approach.
This document discusses ossiculoplasty procedures for reconstructing the ossicular chain in the middle ear. It describes the history of different prosthetic materials used, including wires, homografts, and plastics. An ideal prosthesis is said to be durable, biocompatible, and easy to manipulate. Current prostheses discussed include plastipore covered in cartilage to prevent extrusion, ceramic implants which have higher extrusion rates, and hydroxylapatite which can directly contact the tympanic membrane. Surgical techniques are explained for different ossicular discontinuities classified by Austin and Wullstein. Key factors for success are described as infection control, tissue health, and eustachian tube function.
1) The document discusses the surgical approach and procedure for cortical mastoidectomy. Key steps include raising skin and periosteal flaps, drilling along anatomical landmarks like the sigmoid sinus and facial nerve to identify structures, and widening the aditus and performing a posterior tympanotomy to access the mesotympanum.
2) Post-operative care involves drain removal within 48 hours and dry dressing of the ear. Potential complications discussed are persistent deafness, facial nerve injury, CSF leak, hemorrhage and infection.
3) The patient is advised restricted activity for 3 weeks followed by a gradual return to normal activity over 4 weeks, and to keep the operation site dry.
Tympanoplasty is a surgical procedure to reconstruct the tympanic membrane and/or ossicles that have been damaged. It is classified based on the status of the ossicles and middle ear, such as the Wullstein and Austin-Kartush classifications, which help determine the surgical approach and predict success rates. Factors like the presence of otorrhea, perforation, cholesteatoma, and ossicular chain status are used to calculate a Middle Ear Risk Index that provides a prognosis for tympanoplasty outcomes.
Cholesteatoma is a cyst-like structure in the middle ear filled with skin cells and debris. It can be congenital, arising from embryonic skin cell rests, or acquired through retraction of the eardrum or migration of skin cells through a perforated eardrum. The skin cells in the cholesteatoma produce enzymes that destroy the surrounding bone. Cholesteatoma is evaluated with examination, imaging, and hearing tests. Treatment involves surgery to remove the cholesteatoma and reconstruct the damaged bones.
1. The document describes various anatomical features of the round window membrane, including its shape, thickness, layers, and surgical implications.
2. It notes that the round window membrane is a neglected part of otological surgery but gaining more attention for procedures like cochlear implants.
3. Key structures that support the round window membrane are described, such as the fustis, a bony column that regulates sound wave flow and pressure differences.
1. The facial recess is a collection of air cells located lateral to the facial nerve at the external genu. It can provide a route for middle ear disease to spread to the mastoid area.
2. Opening the facial recess during surgery for chronic ear disease provides additional drainage pathways and better visualization of the middle ear cavity and facial nerve.
3. The landmarks used to expose the facial recess include the external genu of the facial nerve, fossa incudis, chorda tympani nerve, and tympanic membrane. The facial recess is dissected by identifying these landmarks with microscopes and thin-burring the bone between them.
The document provides information about the mastoidectomy procedure:
- It begins with classifications of mastoidectomies as canal wall up (CWU) vs canal wall down (CWD) procedures.
- Surgical anatomy and important structures like the tegmen, sigmoid sinus and facial nerve are discussed.
- Indications for cortical mastoidectomy include mastoiditis and cholesteatoma.
- The procedure involves making a postaural incision, removing the mastoid cortex to expose the air cells and mastoid antrum, and completely clearing out the accessible mastoid air cells while preserving key structures like the tegmen and posterior canal wall.
Cholesteatoma is defined as a cystic bag-like structure filled with desquamated squamous debris lying on a fibrous matrix, also known as "skin in the wrong place." It can be congenital or acquired. Acquired cholesteatomas are either primary, with unknown etiology, or secondary caused by acute necrotizing otitis media. Evaluation involves history, examination, audiometry and CT scan to determine extent. Surgical treatment aims to eradicate the cholesteatoma while preserving hearing, with options like canal wall up or down mastoidectomy depending on the case. Complications can include infection, bone destruction, hearing loss and facial nerve paralysis if
1. A cholesteatoma is a cyst-like sac in the middle ear that is lined with keratinizing squamous epithelium and contains desquamated keratin. It is not a tumor and does not contain cholesterol.
2. Cholesteatomas can be congenital, arising from embryonic cell rests, or acquired through retraction pockets, squamous metaplasia, or migration of epithelium through a perforated eardrum.
3. It expands through bone erosion using enzymes produced by the epithelial lining and inflammatory cells, and can cause hearing loss, facial paralysis, and other complications if left untreated.
1. Mastoidectomy is a surgical procedure that opens the mastoid cavity to clean infected air cells and improve ventilation. It has evolved from simple trephination for acute infections to modern techniques that preserve normal anatomy.
2. The document outlines the history, surgical anatomy, types (cortical, radical, modified radical), indications, and techniques of mastoidectomy. Types are classified as open (canal wall down) or closed (canal wall up) approaches.
3. Potential complications are discussed briefly. Controversies remain regarding the best surgical techniques and approaches to different pathologies.
1. The document discusses the embryology and anatomy of the frontal sinus and frontal recess. It develops from ethmoidal cells that pneumatize into the frontal bone.
2. It describes different surgical approaches to access and drain the frontal sinus including external approaches and various types of endoscopic frontal sinusotomies.
3. Type 1 and 2 endoscopic procedures involve draining the frontal sinus via the frontal recess and removing obstructions. Type 3 is a more extensive procedure that creates a common chamber between the frontal sinus and nasal cavity via an intranasal modified Lothrop procedure.
Cholesteatoma is a cystic lesion formed from keratinizing stratified squamous epithelium in the temporal bone. It has a complex pathogenesis involving both congenital and acquired factors. Congenitally, it may arise from epithelial rests or microperforations. Acquired cholesteatomas develop primarily from invagination or secondarily from implantation, migration, or basal cell changes. Molecularly, cytokines released in response to bacteria promote bone erosion and development of cholesteatoma.
Mastoidectomy is a surgical procedure to access and treat infections of the mastoid air cells behind the ear. Over time, the procedure has evolved from simple cortical mastoidectomies described in the 17th century to more advanced techniques using an operating microscope and drill. Modern mastoidectomies are typically classified as canal wall up or canal wall down depending on whether the bony ear canal wall is preserved. Indications include treatment of cholesteatoma, refractory ear infections, and approaches for other inner ear procedures. The surgery involves an incision behind the ear to access and clean out the infected mastoid air cells.
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
The nasal valve is the narrowest part of the nasal passage located between the septum and upper lateral cartilages. Problems in this area can be due to weak or resected cartilage, or secondary to issues like septal deviations or turbinate hypertrophy. Diagnosis involves visual inspection and using probes to check for collapse or improvement from distraction. Treatment aims to restore normal anatomy and support the nasal framework using techniques like septoplasty, spreader grafts, onlay grafts, and valve suspension to correct primary or secondary valve abnormalities.
This document discusses cholesteatoma, including definitions, classifications, theories of pathogenesis for congenital and acquired types, and management approaches. Cholesteatoma is an abnormal skin growth in the middle ear that can cause bone destruction. It is classified as congenital or acquired primary/secondary. Management involves surgical removal, with the goal of total eradication, to obtain a safe, dry ear. Canal wall down and canal wall up procedures are described. Complications include hearing loss, facial nerve issues, and rare but serious intracranial infections.
The document discusses the anatomy of the sinus tympani, a cavity located in the posterior region of the tympanic cavity. It describes how the sinus tympani was first named and discussed in 1820. It defines the two portions of the retrotympanum based on the position of the facial nerve. It outlines different shapes that the sinus tympani can take, including classical, confluent, partitioned, and restricted, and different types - A, B, and C - based on its extension in relation to the facial nerve. The shapes and types of the sinus tympani can influence the surgical approach used for cholesteatoma surgery.
1. Mastoidectomy is a surgical procedure that opens the mastoid cavity to clean infected air cells and improve ventilation. It has evolved from simple trephination for acute infection to current canal wall preserving techniques.
2. There are several types of mastoidectomy including cortical, radical, modified radical, tympanomastoidectomy, and mastoidectomy with intact canal wall. The procedure performed depends on the extent and location of disease.
3. Key anatomical structures of the mastoid include the mastoid antrum, facial recess, and the relationship between the mastoid and middle/inner ear. Careful identification of these structures is important for safe mastoid surgery.
This document provides an overview of the steps involved in primary sinus surgery via an endoscopic approach. It begins with a brief history of sinus surgery and then discusses preoperative assessment, including CT scans to evaluate sinus anatomy and disease patterns. The basic techniques of Messerklinger and Wigand are described. The key steps of the surgery are then outlined in detail, including uncinectomy, antrostomy of the maxillary sinus, anterior and posterior ethmoidectomy, sphenoid sinusotomy, and frontal sinusotomy when necessary. Throughout, anatomical landmarks and variations are discussed to guide safe dissection and avoid complications.
This document provides an overview of laryngeal framework surgery techniques. It discusses the anatomy of the laryngeal cartilages and muscles involved in voice production. It then describes the history and types of thyroplasty procedures developed to improve voice, including type 1-4 thyroplasties. Type 1 involves medialization of the vocal fold while types 2-4 are used to expand, relax or increase tension on the vocal folds. Other techniques discussed include arytenoid adduction, thyroarytenoid myomectomy, cricothyroid approximation and femlar surgery. Complications and limitations of the procedures are also summarized.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Glomus tumours are benign, slow-growing, hypervascular tumours that originate from glomus bodies in the middle ear. They are most commonly seen in the 5th decade of life and affect females more often than males. On histology, they appear as clusters of cells arranged in a nested pattern surrounded by a vascular stroma. Surgical excision is the primary treatment, though pre-operative embolization of feeding vessels can help reduce blood loss. Glomus tumours can spread locally within the temporal bone and occasionally metastasize to distant sites like the lungs. Advanced cases may require a combined surgical and radiotherapy approach.
This document discusses ossiculoplasty procedures for reconstructing the ossicular chain in the middle ear. It describes the history of different prosthetic materials used, including wires, homografts, and plastics. An ideal prosthesis is said to be durable, biocompatible, and easy to manipulate. Current prostheses discussed include plastipore covered in cartilage to prevent extrusion, ceramic implants which have higher extrusion rates, and hydroxylapatite which can directly contact the tympanic membrane. Surgical techniques are explained for different ossicular discontinuities classified by Austin and Wullstein. Key factors for success are described as infection control, tissue health, and eustachian tube function.
1) The document discusses the surgical approach and procedure for cortical mastoidectomy. Key steps include raising skin and periosteal flaps, drilling along anatomical landmarks like the sigmoid sinus and facial nerve to identify structures, and widening the aditus and performing a posterior tympanotomy to access the mesotympanum.
2) Post-operative care involves drain removal within 48 hours and dry dressing of the ear. Potential complications discussed are persistent deafness, facial nerve injury, CSF leak, hemorrhage and infection.
3) The patient is advised restricted activity for 3 weeks followed by a gradual return to normal activity over 4 weeks, and to keep the operation site dry.
Tympanoplasty is a surgical procedure to reconstruct the tympanic membrane and/or ossicles that have been damaged. It is classified based on the status of the ossicles and middle ear, such as the Wullstein and Austin-Kartush classifications, which help determine the surgical approach and predict success rates. Factors like the presence of otorrhea, perforation, cholesteatoma, and ossicular chain status are used to calculate a Middle Ear Risk Index that provides a prognosis for tympanoplasty outcomes.
Cholesteatoma is a cyst-like structure in the middle ear filled with skin cells and debris. It can be congenital, arising from embryonic skin cell rests, or acquired through retraction of the eardrum or migration of skin cells through a perforated eardrum. The skin cells in the cholesteatoma produce enzymes that destroy the surrounding bone. Cholesteatoma is evaluated with examination, imaging, and hearing tests. Treatment involves surgery to remove the cholesteatoma and reconstruct the damaged bones.
1. The document describes various anatomical features of the round window membrane, including its shape, thickness, layers, and surgical implications.
2. It notes that the round window membrane is a neglected part of otological surgery but gaining more attention for procedures like cochlear implants.
3. Key structures that support the round window membrane are described, such as the fustis, a bony column that regulates sound wave flow and pressure differences.
1. The facial recess is a collection of air cells located lateral to the facial nerve at the external genu. It can provide a route for middle ear disease to spread to the mastoid area.
2. Opening the facial recess during surgery for chronic ear disease provides additional drainage pathways and better visualization of the middle ear cavity and facial nerve.
3. The landmarks used to expose the facial recess include the external genu of the facial nerve, fossa incudis, chorda tympani nerve, and tympanic membrane. The facial recess is dissected by identifying these landmarks with microscopes and thin-burring the bone between them.
The document provides information about the mastoidectomy procedure:
- It begins with classifications of mastoidectomies as canal wall up (CWU) vs canal wall down (CWD) procedures.
- Surgical anatomy and important structures like the tegmen, sigmoid sinus and facial nerve are discussed.
- Indications for cortical mastoidectomy include mastoiditis and cholesteatoma.
- The procedure involves making a postaural incision, removing the mastoid cortex to expose the air cells and mastoid antrum, and completely clearing out the accessible mastoid air cells while preserving key structures like the tegmen and posterior canal wall.
This document provides information about mastoidectomy surgery. It begins with an introduction stating the primary aim of ear surgery is to remove disease and make the ear safe and dry, while preserving hearing if possible. It then discusses the classification of mastoidectomies as cortical, modified radical, or radical, depending on whether the posterior canal wall is removed or retained. The rest of the document details the surgical anatomy, instruments, pre-operative imaging, and techniques for performing a cortical mastoidectomy, which is defined as the complete removal of accessible mastoid air cells while keeping the posterior canal wall intact.
This document provides secrets and tips for success in tympanomastoid surgeries based on the experiences of Dr. Prahlada N B. The key points discussed include:
- Carefully selecting appropriate cases and understanding when not to operate.
- Using good anesthesia techniques like local anesthesia along with general anesthesia.
- Choosing the right surgical approach and technique for each individual patient.
- Mastering incision methods like endaural incisions.
- Performing procedures like canalplasty to improve outcomes.
- Considering whether cortical mastoidectomy is needed in each case.
- Perfecting ossiculoplasty and grafting techniques.
- Providing good post-operative
The mastoid bone is located behind the ear and contains air cells connected to the middle ear. A mastoidectomy is a surgical procedure to remove infections or growths from the mastoid bone in order to prevent further damage to hearing. There are different types of mastoidectomies including simple, radical, and modified radical mastoidectomies, which vary in their approach and extent of bone removal based on the condition being treated. Potential risks of mastoidectomy include injury to the facial nerve or semicircular canals.
Evaluation and Management of Facial Nerve Palsy by Dr.Aditya Tiwari.Aditya Tiwari
The document discusses the evaluation and management of facial nerve palsy. It begins with an introduction and overview of causes, evaluation of nerve function, and goals of management. It then discusses factors governing the timing and treatment of facial nerve palsy, assessment and planning, and specific management techniques. Surgical options including nerve decompression, repair, grafting and transfers are outlined. Non-surgical treatments like physical therapy are also summarized.
Malignant Salivary Gland Pathologies, Tumors & Its Treatment Plan by Dr. Adit...Aditya Tiwari
This document discusses malignant pathologies of the salivary glands. It begins by describing the major and minor salivary glands and notes that malignant neoplasms can exhibit a wide range of behaviors from slow-growing to highly aggressive. It then covers surgical pathology aspects like incidence rates and common tumor types by gland. The document also discusses etiology, cellular origins, WHO classifications, and provides detailed descriptions of common malignant tumor types like mucoepidermoid carcinoma and adenoid cystic carcinoma. It concludes with treatment approaches for different malignant salivary gland tumors.
Surgical anatomy of Infratemporal fossa. by Dr. Aditya TiwariAditya Tiwari
This document provides an overview of the anatomy of the infratemporal fossa. It describes the boundaries, contents, neurovasculature, and communications of the infratemporal fossa. Key structures discussed include the maxillary artery and its branches, the mandibular nerve and its branches, the otic ganglion, and muscles such as the temporalis, lateral pterygoid, and medial pterygoid. Surgical approaches and nerve blocks related to the infratemporal fossa are also summarized.
Time is precious and time is precious. Time is the only commodity which cannot be regained once last. Managing surgical time has many advantages. This presentation describes the advantages of time management during middle ear and mastoid surgeries and describes how to save time during these surgeries.
Anatomy of inner ear by Dr. Aditya TiwariAditya Tiwari
The document summarizes the anatomy and development of the inner ear. It describes how the inner ear develops from the otic placode and otocyst in the early embryo. It then discusses the detailed structures within the inner ear, including the bony and membranous labyrinths, semicircular canals, cochlea, vestibule, and organ of Corti. The organ of Corti contains hair cells and supporting cells that detect sound vibrations and transmit signals to the auditory nerve.
Principles of Radiotherapy in Head & Neck Surgery and Recent Advances A by Dr...Aditya Tiwari
This document provides an overview of radiotherapy principles for head and neck cancer. It discusses that head and neck cancer represents 6% of new cancer cases worldwide and radiotherapy plays an important role in its treatment. It then summarizes the brief history of radiotherapy and different radiation types used including photon beams, electron beams, and particle radiation. The document also covers radiotherapy techniques such as external beam radiotherapy using linear accelerators, brachytherapy, and fractionation schemes.
Skull base anatomy by Dr. Aditya TiwariAditya Tiwari
The document discusses the anatomy and embryology of the skull base. It describes the various bones that make up the skull base, including the sphenoid, occipital and temporal bones. It outlines the boundaries and contents of the different cranial fossae: anterior, middle, and posterior. It also details important anatomical structures in the skull base like the cavernous sinus, foramina, and various nerves and vessels that pass through the skull base. Comprehensive knowledge of the skull base anatomy is important for understanding pathologies and surgical planning.
Lymphatic Drainage of whole Body by Faisal Azmi Faisal Azmi
The lymphatic system helps drain fluid from tissues, defend the body against pathogens, and absorb dietary fats. It consists of lymph vessels, lymph nodes, and lymph which circulates through the body. The main lymphatic ducts are the thoracic duct which drains the left side of the body and passes lymph to the left subclavian vein, and the smaller right lymphatic duct. There are defined regions that lymph nodes drain called lymphatic watersheds. Examining lymph nodes by region helps identify the source of disease spread or primary tumors.
According to the document, over 63 million people in India suffer from significant hearing impairment, though there is a lack of training courses and resources to help these individuals. While India represents a major market opportunity for hearing aid companies, many citizens cannot afford such devices due to low awareness and the fact that just 8000 ear, nose, and throat surgeons must handle over 7875 cases each. The document calls for more collaboration and resources to help the millions of Indians affected by hearing loss.
This document discusses chronic otitis media, including tubotympanic and atticoantral types. Tubotympanic type is a safe inflammation of the middle ear lining, while atticoantral type involves a cholesteatoma sac. Symptoms include ear discharge and deafness. Examination may reveal perforations or debris in the ear canal. Investigations include culture, endoscopy and imaging. Management involves medical treatment like cleaning or antibiotics, with surgery for more severe cases like mastoidectomy or tympanoplasty.
Sinusitis in children is inflammation of the paranasal sinuses that can be acute (<4 weeks), subacute (4-12 weeks), or chronic (>12 weeks), with symptoms like congestion and rhinorrhea that are difficult to evaluate in young children; it is often multifactorial in etiology and treatment involves differentiating severity, considering comorbidities like allergies, and using medical treatments initially with surgical options like adenoidectomy or FESS as needed.
This document discusses atticoantral chronic suppurative otitis media (CSOM), characterized by persistent discharge, deafness, and marginal perforation with cholesteatoma. Cholesteatoma is a cyst-like structure containing keratinizing squamous epithelium that can grow independently and erode bone. CSOM is diagnosed based on symptoms and examination findings, and treated surgically to eradicate the disease and prevent complications through procedures like mastoidectomy and tympanoplasty. Complications can be extracranial like facial nerve palsy or intracranial like meningitis.
This is the presentation by Dr. Padmal De Silva - Head of the Research Unit, National Institute of Health Sciences, Sri Lanka done on the inauguration of Medical Research Consortium. http://learnent.net/research-symposium-dgh-hambantota/
This document discusses the approach to patients with cholesteatoma. It describes the typical symptoms of cholesteatoma such as persistent foul-smelling otorrhea and progressive hearing loss. Diagnosis involves otomicroscopy, CT imaging, and audiology testing showing conductive hearing loss. Surgical management aims to completely remove the cholesteatoma and may involve either canal wall up or canal wall down approaches depending on factors like disease extent and hearing status. Post-operative care and measures to prevent complications are also outlined.
Chronic Otitis Media - Squamosal type ( UG)AlkaKapil
Chronic Otitis Media - Squamosal / atticoantral/ unsafe Type
Theories of cholesteatoma
cholesteatoma
levenson's criteria
congenital cholesteatoma
classification of cholesteatoma
sade's classification of retraction of pars tensa
Toss classification of pars flaccida retraction
cholesterol granuloma
clinical features of Squamosal CSOM
Complications of COM/CSOM
Investigations - HRCT Temporal bone
Mastoid exploration
cortical mastoidectomy
modified radical mastoidectomy
Radical mastoidectomy
Mastoidectomy is a surgical procedure to access and treat infections or diseases of the mastoid air cells behind the ear. The summary describes:
1. The history of mastoidectomy dates back to ancient times, with modern improvements like the operating microscope in the 20th century.
2. There are different classifications of mastoidectomy based on the extent of air cell removal and whether the ear canal wall is intact or removed.
3. Indications for mastoidectomy include treatment of infections, drainage of abscesses, and approaches for other inner ear surgeries. Complications can include injuries to nearby structures like the dura, facial nerve or blood vessels.
This document summarizes chronic suppurative otitis media (CSOM), which is a chronic inflammation of the middle ear cleft caused by bacterial infection. It discusses the two types of CSOM - tubotympanic and atticoantral - and their respective characteristics and complications. Tubotympanic CSOM mainly affects the middle ear mucosa and has fewer complications, while atticoantral CSOM affects deeper structures in the ear and is associated with more severe complications like cholesteatoma formation. The document outlines treatments for CSOM including conservative management and surgical procedures like tympanoplasty and mastoidectomy. Potential complications of suppurative otitis media affecting
This document discusses cholesteatoma and chronic suppurative otitis media (CSOM). It defines cholesteatoma as an epidermal inclusion cyst in the middle ear containing keratin. It classifies and evaluates cholesteatoma and CSOM. It discusses complications of CSOM such as facial paralysis, labyrinthitis, and intracranial infections. It recommends treatment of cholesteatoma with mastoidectomy and treatment of CSOM with topical antibiotics, regular aural toilet, and control of granulation tissue.
7 chronic suppurative otitis media with and without cholesteatomaSumit Prajapati
This document discusses chronic suppurative otitis media, both with and without cholesteatoma. It defines these conditions, describes their pathogenesis and risk factors. Diagnosis involves history, exam, and CT scan. Treatment for chronic suppurative otitis media without cholesteatoma involves topical antibiotics and tympanoplasty, while treatment for chronic suppurative otitis media with cholesteatoma often requires additional mastoidectomy. Complications can arise from bone destruction or infection spreading to nearby structures like the brain.
7 chronic suppurative otitis media with and without cholesteatomaSumit Prajapati
This document discusses chronic suppurative otitis media, both with and without cholesteatoma. It defines these conditions, describes their pathogenesis and risk factors. Diagnosis involves history, exam, and CT scan. Treatment for chronic suppurative otitis media without cholesteatoma involves topical antibiotics and tympanoplasty, while treatment for chronic suppurative otitis media with cholesteatoma often requires additional mastoidectomy. Complications can arise from bone destruction or infection spreading to nearby structures like the brain.
This document discusses cholesteatoma and chronic suppurative otitis media (CSOM). It defines cholesteatoma as the presence of keratinizing squamous epithelium in the middle ear or mastoid. Theories on the origin of cholesteatoma include retraction of the tympanic membrane or migration of squamous epithelium through a perforation. CSOM is a long-standing middle ear infection characterized by discharge and permanent perforation. It is classified as tubotympanic or atticoantral, with atticoantral being more dangerous due to higher risk of complications like cholesteatoma and bone erosion. Treatment involves surgical removal of disease or conservative management
Cholesteatoma and chronic suppurative otitis mediaainakadir
This document discusses cholesteatoma and chronic suppurative otitis media (CSOM). Cholesteatoma is defined as the presence of keratinizing squamous epithelium in the middle ear or mastoid. There are various theories for its origin, including invagination of the tympanic membrane or basal cell hyperplasia. CSOM is a long-standing middle ear infection characterized by ear discharge and permanent perforation. It is classified as tubotympanic or atticoantral, with atticoantral being more dangerous due to higher risk of bone-eroding complications like cholesteatoma. Treatment involves surgical resection for atticoantral CSOM and conservative
This document discusses the natural history and management of active squamous cholesteatoma. It notes that cholesteatoma can remain active or become inactive over time. Surgical removal is the primary treatment and can be done via canal wall down mastoidectomy or intact canal wall mastoidectomy. Canal wall down mastoidectomy has a lower recurrence rate of 5-15% but often results in a larger cavity that requires more care, while intact canal wall mastoidectomy has a higher recurrence rate of 20-25% but preserves the ear anatomy. Post-operative care and potential cavity issues are also outlined.
Tympanoplasty is defined as a procedure to eradicate disease in the middle ear and reconstruct the hearing mechanism, with or without grafting of the tympanic membrane. The goals are to achieve a dry ear and improve hearing by closing perforations and reconstructing the ossicular chain. Ossiculoplasty aims to correct ossicular chain abnormalities to improve hearing. Various graft materials, classifications of ossicular defects, surgical techniques, and complications are discussed.
The document describes the anatomy and clinical features of the external auditory canal. It discusses the following key points:
- The external auditory canal has both cartilaginous and bony portions, with the bony portion making up the medial two-thirds. It is lined by skin that grows obliquely to prevent blockage.
- Aural atresia is the absence or closure of the external auditory canal. It can be congenital or acquired. Types include minor, moderate, and severe aplasia. Surgery aims to reconstruct the canal but has risks.
- Acquired atresia is due to inflammation, trauma, burns or previous ear surgery. It can be solid from
1) Retraction pockets and atelectasis occur when parts of the eardrum lack an elastic layer, causing the eardrum to retract inward and accumulate debris.
2) Perforations of the eardrum can be central, marginal, or attic. Marginal perforations involve the fibrous annulus and are associated with bone disease and cholesteatoma formation.
3) Chronic otitis media can be non-suppurative (e.g. serous or glue ear) or suppurative (e.g. tubo-tympanic or attico-antral disease), which is more destructive and dangerous.
1. Chronic suppurative otitis media (CSOM) is a long-standing middle ear infection characterized by ear discharge and permanent perforation of the eardrum. It is more common in developing countries and affects people of all ages and sexes.
2. Cholesteatoma is a type of CSOM where the disease spreads to the bony walls of the middle ear, posing risks of dangerous complications. It is associated with a buildup of skin cells (cholesteatoma), inflammation (osteitis), and granulation tissue in the middle ear.
3. Treatment options include surgical procedures like canal wall up or canal wall down mastoidectomies to remove
The document discusses various types of ear surgery including myringotomy, tympanoplasty, mastoidectomy, stapedectomy, and cochlear implantation. It provides details on the anatomy of the ear, surgical approaches, procedures, indications, techniques, complications, and postoperative care for each type of ear surgery. The goal of these surgeries is to treat conditions like infections, perforated eardrums, hearing loss and remove diseased tissue from the middle ear, mastoid bone or inner ear.
This document defines tympanoplasty and provides a history and overview of the procedure. It begins by defining tympanoplasty as a procedure to eradicate disease in the middle ear and reconstruct the hearing mechanism, with or without grafting of the tympanic membrane. It then discusses the history of developments in tympanoplasty techniques from the 1950s onward. The document outlines the aims, objectives, types based on various classification systems, indications, contraindications and steps of performing tympanoplasty.
A 22 year old male presented with left earache and discharge for 2 weeks. On examination, his left tympanic membrane was bulging and erythematous. He was diagnosed with acute otitis media. Treatment involves topical and oral antibiotics as well as analgesics to manage pain. Surgical drainage may be required if symptoms persist despite medical management. The nurse's role includes assessing pain, monitoring for complications, providing patient education, and ensuring a safe recovery.
Chronic suppurative otitis media (csom)Aditi Kataria
Chronic suppurative otitis media (CSOM) is a long-standing inflammation of the middle ear that causes intermittent or continuous ear discharge and hearing loss. It can be classified as tubotympanic or atticoantral depending on the area of involvement. Atticoantral CSOM poses higher risks due to complications like cholesteatoma that can destroy local bones. Treatment involves surgery like cortical mastoidectomy for drainage or radical/modified radical mastoidectomy to fully remove the disease.
The document discusses various ear procedures including myringotomy, mastoidectomy, and tympanoplasty. Myringotomy involves incising the tympanic membrane to drain fluid from the middle ear, often used to treat acute otitis media. Mastoidectomy clears disease from the middle ear, epitympanum, and mastoid bone, creating a single cavity for drainage. Tympanoplasty aims to reconstruct the hearing mechanism after clearing chronic ear disease, and there are five types involving repair or reconstruction of different parts of the ear.
This document discusses open cavity mastoid operations, including their history, indications, techniques, and complications. Open cavity procedures involve removing the posterior wall of the external auditory canal to exteriorize the mastoid cavity. They allow for monitoring of recurrent cholesteatoma and drainage for unresectable infections. The radical and modified radical mastoidectomies developed historically to fully remove bone-invading disease while preserving hearing when possible. Key steps involve identifying and preserving the facial nerve while removing disease-affected areas. Postoperative care focuses on re-epithelialization of the cavity and monitoring for complications like infection, nerve injury, and recurrent cholesteatoma.
Similar to Canal wall up Mastoidectomy ( Intact Bridge Mastoidectomy) by Dr.Aditya Tiwari (20)
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
3. INTRODUCTION
Desciption of chronic and suppurative infections
of the mastoid have been discovered dating back
to ancient Greece.
Mastoid surgery has evolved from simple
trephination for acute infections, to the canal wall
preserving mastoidectomy.
The complete (or simple) mastoid operation,
refers to canal-wall-up (CWU) mastoidectomy,
with complete removal of diseases from temporal
bone lateral to otic capsule.
It is usually accompanied by tympanoplasty &
ossicular chain reconstruction.
4. HISTORY
Mastoid operation have been employed for over 300
years to control suppurative diseases of the ear, but
first proposed mastoidectomy date back more than
four centuries.
Ambrose Pare proposed to operate on skull & drain
pus.
Jean Petit of Paris reported the first successful mastoid
trephination operation in late 1700s.
The first postauricular incision was introduced in 1853
by Sir Willian Wilde of Dublin.
Schwartze & Eyeshell reported the use of cortical
mastoidectomy for management of acute mastoid
infections.
5. Zaufal, in 1890, described the radical mastoidectomy with
the additional removal of the TM, ossicles & post. wall of EAC.
Bondy described opening the epitympanum and leaving the
middle ear intact.
In 1902, Sir Charles Balance was the first to advocate the
complete mastoid operation for control of advanced
suppuration of the ear.
Lempart popularised the use of a drill & loupe magnification
in the 1928.
With the introduction of Zeiss operating otologic microscope
in 1923 & description of CWU mastoidectomy by JANSEN, the
paradism for mastoid surgery changed dramatically for acute
& chronic mastoid infections.
1958, the canal wall up mastoid was then popularized by
House. He also introduced the suction irrigation system and
retractors in mastoid surgery.
6. RELATION OF THE MASTOID ANTRUM
There are four parts to
the temporal bone:
petrous, tympanic,
mastoid, and squamous
A transmastoid
procedure allows access
to the facial nerve,
internal carotid, jugular,
and internal auditory
canal
9. PATHOPHYSIOLOGY
Primary role of CWU mastiodectomy is in the control of
chronic otitis media, with and without cholesteatoma &
acute mastoiditis.
It is also used as a standard approach for cochlear
implantation, excision of tumors & surgery for vertigo.
Incision & drainage of subperiosteal abscess,& placement
of tympanostomy tubes & antibiotics, without
mastoidectomy, suffice in the treatment of most of cases of
acute mastoiditis.
10. Acute mastoiditis arises from untreated acute otitis
media, otitis media that fails to respond to antibiotics.
Coalescent mastoiditis is acute mastoiditis in which a
localised collection of pus has accumulated in the
mastoid, with evidence of erosion of the normal bony
septae within the mastoid cavity.
Persistant purulent otorrhea for more than 3 weeks
after AOM, pain behind the ear, or pain deep in the ear
are indications that coalescence may be developing.
Many signs & symptoms seen in both AOM &
coalescent mastoiditis, but their persistance 2-3
weeks after the onset of infection is more s/o
coalescent mastoiditis.
11. It can present as a postauricular subperiosteal
abscess & definatively diagnosed by CT scan.
Subacute mastoiditis – slow, silent progression of a
coalescent abscess, is a potentially dangerous
consequence of partially treated AOM. It evolves over
several weeks.
CSOM defined as chronic inflammation of the middle
ear & mastoid, can be seen with or without
cholesteatoma.
Most commanly it manifests as hearing loss &
intermittant otorrhea. Usually painless but acute
condition is painful. Vertigo is uncomman but if
present concerns for labyrinthine fistula or
inflammation.
12. Pathologic findings of CSOM includes osteitis (most
often seen in ossicle, otic capsule & mastoid bone) ,
mucosal edema with submucosal gland formation,
granulation tissue, tympanosclerosis, cholesterol
granulomas, cholesteatoma, & TM retraction and
perforation.
Bone erosion from osteitis can result in ossicular
discontinuity, dural exposure with or without brain
herniation, meningitis & labyrinthine fistula.
Granulation tissue most commanly seen in
epitympanum & round window niche, blocking the
aditus preventing aeration of the mastoid &
subsequent resolution of infection.
13. ETIOLOGY OF CSOM
CSOM is believed to caused by
1. ETD persistant middle ear discharge
(serous/purulent) mucosal edema formation of
granulation tissue.
2. Bacterial infection via chemical mediators
Granulation tissue formation initiated in inflamed
mucosa bacterial toxin + inflammatory mediators
acts on edematous mucosa rupture of the BM of
epithelia
Inflammatory cells in underlying lamina propria
extrude through BM secrets AGF, EGF leads to
fibroblast recruitment, neovascularisation & polyp
formation.
14. TM affected by the enzymes contained in the granulation
tissue & chronic effusion breaks down its collagen
skeleton.
The weakening of TM & negetive pressure in the middle
ear from ETD develops retraction pocket in the TM.
Deepening of the retraction pockets leads to contact with
the underlying mucosa or granulation tissue & fibrous
band cause perforation.
Deep retraction pockets & perforation set the stage for the
genesis of cholesteatoma.
15. DIAGNOSIS
ACUTE MASTOIDITIS:-
a) Begins as AOM Deep thrombing ear pain with
asso. with pus in the middle ear purulent
otorrhoea.
b) TM erythematous & bulges laterally
c) Fever, leukocytosis, tender mastoid, tender post
auricular skin
COALESCENT MASTOIDITIS:-
a) AOM persisting over days or weeks after
infection
b) Disproportionate deep pain, mastoid tenderness,
erythema or swelling.
16. CSOM:-
a) Foul smelling intermittant otorrhoea, hearing loss,
otalgia, headache.
b) Conductive hearing loss is comman. Its greater than
30dB suggest ossicular erosion. SNHL ranging from 5
to 33 Db.
c) EAC should be noated for edema, cholesteatoma. TM
should be noated for perforation, retraction,
atelectasis, or cholesteatoma.
d) Look for scutum erosion, ossicular erosion,
granulation tissue, vertigo(raising suspicion of
labyrinthitis or fistulas)
17. PAEDIATRIC CHOLESTEATOMA
Cholesteatoma is more aggressive in paediatric patients
due to the following reasons:-
a) Immature eustachian tube facilitate TM retraction &
cholesteatoma
b) Increased amount of growth factor in children faster
growth rates in cholesteatoma
c) Increased & better aeration in paediatric patients
facilitate spread of cholesteatoma through middle ear &
mastoid complicate disease removal
d) Faster replication rate of keratinocytes in paediatric
cholesteatoma Vs adults.
18. TREATMENT
MEDICAL TREATMENT
a) Broad spectrum antibiotics – oral or i.v.
b) Ototopical antibiotics.
c) Insertion of tympanostomy tube.
d) Analgelsics.
e) Antihistaminics.
f) Antacids – oral or i.v.
19. SURGICAL THEORY & PRACTICES
Simple Mastoidectomy
Closed or Canal Wall Up Mastoidectomy
a) Cortical mastoidectomy
b) Combined approach tympanoplasty
c) Tympanoplasty with mastoidectomy
Open or Canal Wall Down Mastoidectomy
a) Atticotomy
b) Radical mastoidectomy
c) Modified radical mastoidectomy
20. Modifications of intact canal wall Mastoidectomy:
1) Atticotomy with preservation of the intact
bony bridge
2) Atticotomy with preservation of a partly
resorbed bony bridge
3) Atticotomy with removal of the bridge
4) Widening of the ear canal
Atticotomy openings of various sizes with
preservation of the intact non resorbed bony
bridge
The goal of this atticotomy is to obtain a good view
into the anterior attic. The bridge remains in its
normal position
21. DEFINITIONS
Cortical mastoidectomy:- This is an operation
performed to remove the mastoid antrum & air cell
system and aditus & antrum, with preservation of
intact post. bony EAC wall without disturbing the
existing middle ear content.
Combined approach tympanoplasty:- This is an
operation performed to remove disease from the
middle ear & mastoid by the way of
a) the mastoid
b) a posterior tympanotomy, &
c) the transcanal route, followed by the
reconstruction Of the middle ear transformation
mechanism
23. Tympanoplasty with mastoidectomy:- This is an
operation performed to eradicate disease from the
middle ear and mastoid & to reconstruct the hearing
mechanism with or without tympanic membrane
grafting. e.g.
a) Combined approach tympanoplasty or cortical
mastoidectomy with tympanoplasty
b) Obliteration technique – muscle or other
obliteration of an open mastoid cavity with
tympanoplasty
c) Canal wall reconstruction technique –
reconstruction of the outer attic post. Canal wall of
an open mastoid cavity, with tympanoplasty
d) Open cavity technique – open or canal wall down
mastoidectomy with tympanoplasty
24. ATTICOTOMY- remove all part of outer attic wall( scutum)
and adjacent deeper post meatal wall to expose the attic
(epitympanum) and when necessary the aditus and
antrum to gain acess to these sites and their content and /
or to remove disease limited to this site
RADICAL MASTOIDECTOMY- to eradicate all middle ear
and mastoid disease , in which mastoid antrum and air cell
system ( when present) , aditus and antrum, attic and
middle ear( mesotympanum and hypotympanum) are
converted in to a common cavity exteriorzed to the
external auditory meatus. During this procedure TM, incus,
malleus all removed except stapes ( foot plate alone or with
stapes supra structure if healthy.
RM- TM or reminant thereof and ossicular remenants
( usually the malleus handle and stapes) are retained
25.
26. INDICATIONS
3 priorities in surgery for CSOM are :-
a) eradication of disease
b) prevention of disease recurrence
c) preservation or restoration of hearing
Mastoidectomy in CSOM has 3 primary
indications :-
a) eradication of disease & infection
b) approach for removal of cholesteatoma
c) establishing aeration
d) previous tympanoplasty failure & perforated TM
with persistant suppurative drainage.
27. CONTRAINDICATIONS TO CWU
MASTODECTOMY
1) Unresectable posterior canal wall defect
2) Patient in which proper follow up is questionable
3) Unresectable matrix involving the labyrinth, facial
nerve, carotid, dura, sinus tympani.
4) Only hearing ear
5) Patients with labyrinthine fistula
6) Long-standing ear disease
7) Poor eustachian tube function
Active infection &
otorrhoea are not c/i
to surgery, but ear
should be made dry
pre op. since the rate
of post op infection is
higher when an ear is
operated while
draining.
28. PREOPERATIVE EVALUATION
Preoperative audiometry.
IMPEDENCE
X RAY mastoid
HRCT scan of the Temporal bone.
(pneumatization, and position of the tegmen and
the sigmoid sinus and extend of the disease)
EUM
29. PRE-OP COUNSELING - RISKS OF SURGERY
Facial paralysis
Vertigo
Tinnitus
Hearing loss
Staged procedure
Need for long term follow-up and routine aural
toilet
30. OPERATIVE TECHNIQUE FOR CWU
MASTODECTOMY
PREPARATION
Pre operative antibiotic or steriods
Supine position with head turned away from affected
ear
Hair may be shaven if it is in the operating field, or
taped to keep it out of the field.
Injection with lignocaine with epinephrine
(postaurally and canal skin in sup. , post, inf )
Antibiotics ( ciprofloxacin 400 mg iv or betadine soln
mixed with saline) for irrigation
32. Retroauaral approach Endaural approach
Attic is oblique in postero
anterior direction,
distance to attic is longer.
Mastoidectomy is easy to
be extended
Cavity obliteration by
flaps is possible
Both trans meatal and
transcortical routes can
be taken
Cavities produce is larger
Attic view is direct latero
medially and distance to
attic is shorter
Difficult to extend
Cavity obliteration not
possible
Posterior tympanum and
sinus tympani is better
viewed
Only transmeatal route is
route of choice
Cavities produce is
33. ROUTES: (BONE)
Transcortical
starts over cortex of mastoid process
also described as outside in
Transmeatal
starts in the bone of ear canal
also described as inside out
atticotomy antrostomy retrograde
mastoidectomy
34. SIMPLE MASTOIDECTOMY
Indication –
1) acute mastoiditis,
commonly called
“coalescent mastoid”
2) Medical management
failure of chronic
suppurative otitis
media/mastoiditis
3) As an approach to:
a) Facial nerve decompression
b) Endolymphatic sac
decompression
c) Labyrinthectomy
35. A post-auricular 1cm post. to sulcus approach is used .
Young children the mastoid tip is not well developed
and the stylomastoid foramen is located more
superficially, making the facial nerve vulnerable to
surgical trauma. The inferior aspect of the incision is
more posterior and is not carried down as far to avoid
injuring the facial nerve .
36. Carry the incision to the loose areolar tissue over the
temporalis facia..
CORTICAL MASTOIDECTOMY
The cortex is exposed by an
incision through the linea
temporalis, with a vertical cut
extended to the posterior
mastoid tip, in a T fashion. An
elevator is then used to free the
cortex off the soft tissue.
C shaped incision provides better exposure in a previously
drilled cavity, prevent injury to the important underlying
structure such as sigmoid sinus & middle cranial fossa.
37. Cortex exposed
a) Sup. - over the tegmen
b) Post. - over sigmoid
sinus
c) Ant. - level of EAC
meatus
d) Inf. – mastoid tip
Self retaining retractors
are positioned and the
surface landmarks are
identified,which include
the spine of Henle,
cribriform area, & linea
temporalis.
38.
39.
40. MacEwen’s triangle shows the
location of the antrum.
MacEwen’s triangle is defined as
the posterior EAC border, the
anterior line of the zygomatic
arch and the line that connects
the two.
The antrum is 15 mm medial the
this.
Removing bone along the linea
temporalis
Identify underlying tegmen ( pink
hue)
Middle cranial fossa dura
delineated to its superior extend.
41. CANALPLASTY
Using 2mm diamond burr, excess tympanic bone at
the tympanomastoid & tympanosquamous suture line
is removed.
If required, the entire EAC can be enlarged, from 12
o’clock to 6 o’clock position posteriorly.
The distance of facial nerve from the annulus in the
posterior-inferior quadrant of the EAC ranges from
1.9mm to 5.7mm facial nerve is at most risk to
injury during surgery.
Often removal of this small amount of bone greatly
improves the exposure, ensuring better disease
resection & graft placement.
43. Various drills are available and there are common
principles related to bur selection
Larger bur preferred over smaller ones when possible
A bur with a cutting surface is selected for cortical
bone, were diamond grain surface is for removing the
last layer of bone over facial nerve, sigmoid sinus,
tegmen, & opening the facial recess.
Suction irrigation is critical to prevent excessive heat
transfer to underlying structures & to keep the bone
cool.
Diamond burrs are effective at controlling bleeding in
the bone by driving bone dust into the lumen of the
small vessels
Also, it is important to “saucerize” the edges of the
mastoid cavity to provide visualization.
44. Cortical bone removed post to EAC (post- sigmoid
sinus bluish hue and sinodural angle , inf-
mastoid tip). Cortical bone is removed inferiorly
to the mastoid tip
Surface of the tegmen followed medially towards
the antrum and the air cells are exposed.
KOERNER SEPTUM
penetrated
ANTRUM
45.
46. Dural plate and lateral
semicircular canal
Postero-anterior view through
antrotomy and aditus ad
antrum into epitympanum
Dural
plate
LSSC
BODY OF
INCUS
SHORT
PROCESS
FACIAL
NERVE
DURAL
PLATE
LSSC
47. Sigmoid sinus, sinodural angle
and dural plate
Correct length of a cutting burr in
the drill
A diamond burr can be
lengthened in order to safely drill
deeper in the mastoid
DURAL
PLATE
SINODURAL
ANGLE
SIGMOID
SINUS
48. SIMPLE (DISEASED) CANAL WALL UP
MASTOIDECTOMY
This is an extension of the simple mastoidectomy
with greater access to the attic, labyrinth,
endolyphatic sac, antrum and facial nerve.
Opening of the aditus ad antrum allows access to
the epitympanum, and the incus and malleus may
be removed for greater access
The canal wall remains up.
49. INDICATIONS
Treatment of Cholesteatoma & suppurative mastoiditis
Exposure of mastoid segment of facial nerve.
Cochlear implant, in which a posterior tympanotomy is
part of the procedure
Labyrinthectomy and mastoid trauma
Retrolabyrinthine approachs to the vestibular nerves
Exposere of the sigmoid sinus for obliteration before
petrosectomy
50. Exposure of the mastoid region in CAT, to
delineate the descending portion of the
facial nerve & to provide the access for
opening the posterior tympanotomy into
the middle ear.
Saccus decompression surgery, to offer the
safest & widest access to the posterior fossa
dura.
Translabyrinthine operations, to provide
the exposure of the bony labyrinth needed
for its exenteration to allow access to the
IAM.
51. ATTIC DISSECTION POST.
EPITYMPANOTOMY
Performed by following the tegmen anteriorly & by
thining the canal wall posteriorly & superiorly.
Canal wall thinned laterally to medially.
Drilling out of zygometic root opening of the attic
Granulation & cholesteatoma removed.
Attic cell are opened completely & fully exposed in
any epitympanic disease. Ant. attic is most comman
site of residual disease.
As the epitympanum approached from the post to
ant,the tegmen is carefully followed as it usually dips
inferiorly.
52. After the Dissection , the anterior epitympanum,
zygomatic cells, body of incus and head of malleus are
identified.
Cultures can then be taken from the mastoid mucosa,
if needed.
53. FACIAL NERVE:-
IDENTIFICATION is most
important to avoid injury
Travels as GG sup to
cochleariform process &
oval window. Post to oval
window takes inf. turn to
take on a more vertical
course.
LSC lies just sup to facial
nerve as it complete it
transition to the vertical
segment.
54. SECOND GENU is located a few mm
anteromedial to the lat. SSC & is ANATOMICAL
LANDMARK for localizing the facial nerve.
Diagrastric ridge another land mark
Burr stroke should be the parallel to the
course of the nerve
Its gently uncovered until it is observed
through a thin layer of bone.
If the disease is limited to the antrum,
uncovering the vertical segment of the facial
nerve is rarely done.
55. Relations of VIIn to short process of incus;
superior semicircular canal (SCC); lateral
semicircular canal (LSC); posterior semicircular
canal (PSC); dura; and sigmoid sinus
DURA
SSC
SIGMOID SINUS
FACIAL
NERVE
INCUS
LSC
56. Distal portion of mastoid segment of facial
nerve (arrow) is identified close to digastric
ridge
57. FACIAL RECESS (POST. TYMPANOTOMY)
Not required in all CWU mastoidectomy, employed
only when dictated by the location of the disease.
Thin the posterior canal wall
Boundaries:-
a) Superior: Incus or incus buttress
b) Posterior: Facial nerve
c) Anterior: Bony EAC , chordae tympani
d) Inferior: Bifircation of facial nerve &
chordae tympani
59. Access to the mesotympanum can be gained by
removing the bone in the facial recess after thinning
the post. canal wall.
For additional exposure, the facial recess can be
extended inf. by sacrificing the chorda tympani nerve.
Entire mesotympanum &
hypotympanum can usually be
accessed through the mastoid by the
extended facial recess approach.
60. Chorda tympani nerve is identified as it branches off
the vertical segment of the facial nerve & traced sup.
Toward the incus.
Facial recess is opened with a 2 mm diamond burr,
starting sup. where it is widest.
EXTENDED FACIAL RECESS approach involve sharply
sectioning the chorda tympani nerve & extending the
recess ear inferior along the facial nerve course.
The lateral boundary of the exposure becomes the
annulus of the tympanic membrane.
61.
62. Landmarks for posterior tympanotomy
A) VIIn, B) chorda tympani & C) short process of
incus
A
B
C
63. FACIAL RECESS
A = antrum, C = chorda tympani, F = facial nerve, HSC
= horizontal semicircular canal, I = incus, R = round
window, S = stapes
64. EPITYMPANOTOMY
If the cholesteatoma does not extend significantly into
the epitympanum, an epitympanotomy (atticotomy) is
performed
This involves exposure of the head of the malleus and
the incus to remove soft tissue from the epitympanum.
The lateral wall of the epitympanum or attic is
removed with a diamond burr; drilling is commenced
at 12 o’clock relative to EAC, taking care not to make
drill contact with the malleus or incus which is
immediately medial to the outer attic wall, or to breach
67. EPITYMPANECTOMY
This is indicated when cholesteatoma extends medial
to the ossicles or overlies the lateral semicircular
canal; in cases of bony erosion of the ossicles due to
cholesteatoma, the ossicles need to be removed
The incus is removed by mobilising it with a 2,5mm.
45° hook and rotating it laterally, taking care not to
injure the underlying facial nerve .
The malleus head is severed with a malleus nipper
applied across its neck.
68. The head of the malleus is removed leaving the
tensor tympani tendon intact.
Clear cholesteatoma from the epitympanum.
Detailed knowledge of facial nerve anatomy is
crucial to avoid injury to the nerve when drilling or
removing cholesteatoma in the epitympanum.
The tympanic and labyrinthine segments and
geniculum all lie in this very confined space and
may be dehiscent.
The tympanic segment lies in the floor of the
anterior epitympanic recess.
69. Anatomy of anterior epitympanic recess: Facial nerve
(VIIn); Tegmen tympani (TT); Cog; Supratubal recess
StR; Cochleariform process (CP); Eustachian tube (ET
TT
VIIn
Cog
StR
CP
TTymp
ET
70. The cochleariform process is a fairly consistent
landmark and the nerve lies directly superior to it;
the semicanal of the tensor tympani is sometimes
mistaken for the facial nerve; however this canal
ends at the cochleariform process.
The Cog is a bony process in the anterior
epitympanum which extends from the tegmen
tympani and points to the facial nerve.
Geniculate ganglion and GSPN seen once the Cog
and cochleariform process have been drilled away
(as shown follow)
71. View of epitympanum with cog and cochleariform process drilled
away: Tympanic (VII.T) and Labyrinthine (VII.L) segments of
facial nerve and Geniculate Ganglion (GG) and Greater Superficial
Petrosal nerve (GSP); Superior Semicircular Canal (SSC); Lateral
Semicircular Canal (LSC); Dura; Tensor Tympani tendon (cut)
(TeT)
73. FISTULA OF LSC
A small dimple or flatttening in the matrix
covering the bone over LSC may believe as a
fistula
LARGE SMALL
Greater then 2 mm diameter Smaller then 2 mm
diameter
Convert it in to a canal wall
down procedure
Second look procedure 12
month later or repair it by
fascia or perichondrium
76. Aditus enlarged to readily visualise incus
epitympanum inspected through the aditus &
antrum.
The facial recess & sinus tympani are exposed
& cleared of disease tympanoplasty is
accomplished.
A silicone rubber sheet may be placed,
extending from the middle ear into the
antrum ensures the free flow of air between
the middle ear & mastoid cavity.
78. Incus identified & aditus enlarged
to expose attic
Critical oval window area & recess
visualised through a) canal &
b)mastoid
Complete
mastoidectomy
79. Open Cavity Mastoidectomy
Excision of the conchal cartilage via endaural or
postaural approach Korner flap or endaural
incision to creat a flap can be constructed
connect them with post. incision parallel to
tympanic annulus.
The endaural incision extended from the post.
annulus incision in EAC to conchal bow large
crescent shaped piece of conchal cartilage
removed without injuring canal skin & retaining
continuity with the Korner flap.
80. To provide an opening adequate to allow
drainage & surgical defect, meatoplasty should
comfirtably accept the surgeon’s finger.
To prevent post op. stenosis by granulation
tissue formation curettage, steroid antibiotic
ointment, Thiersch grafting using very thin
split thickness skin (3 weeks after surgery).
If stenosis occurs, it will be necessary to
elevate & preserve meatal skin & to drill or
curette the bone widely to creat a large meatus.
81. Completed mastoidectomy with tympanoplasty a) Conchal
cartilage is excised to create a large meatus. & b) Korner flap
is developed
82. The graft is placed in position(a). & the musculofacial
pedicle is placed into the finished mastoid cavity(b).If
it is large, post. Wound will be sutured & drained &
the Korner flap placed on top of the muscle through
an endaural exposure.
84. DISADVANTAGES OF CWU
Technically more difficult
Staged operation often necessary
Higher chances of recurrent or residual
disease
Residual disease harder to detect
Children with cholesteatoma
2nd look is required to rule out recurrence
or residual disease.
Periodical & meticulous follow up needed.
85. COMPLICATION
It occurs as a result of :–
a) Inadequete surgical exposure
b) Failure to recognize the anatomical variation.
c) Granulation or bleeding obscuring the surgical
field.
They are as follows-
86. 1) Bleeding due to injury to the jugular bulb and
dural plate or sigmoid sinus
2) SNHL high frequences losses
3) Vertigo
4) Infection
5) Granulation tissue
6) Brain herniation
7) CSF leak
87. 6) Intracranial injury:-
a) Exposure of dura with spinal fluid leak
b) Small herniation of brain (less than 5mm)
managed with gentle bipolar cautery.
c) Large herniation of brain (more than 5mm)
managed with middle fossa craniotomy approach,
with the assistance of nerurosurgeon
88. 7) Facial nerve injury:-
a) Mastoidectomy is the most comman cause of iatrogenic
facial nerve palsy.
b) When graeter than 50% of nerve is transected, managed
by resecting the injured segment & grafting the nerve.
c) In case of subtotal transection of the facial nerve, it is
proximally & distally decompressed and injury is assessed.
8) Suppurative labyrinthitis.
9) Postauricular haematomas ( if the patient coughs
or strains during the postoperative period)
89. REFERENCES
Bailey BJ, et al, eds. Head and Neck Surgery -
Otolaryngology. 4nd ed. Philadelphia Pa: Lippincott-
Raven; 2006
Antonelli PJ, Dhanani N, Giannoni CM, et al. Impact of
resistant pneumococcus on rates of acute
mastoiditis. Otolaryngol Head Neck
Surg. Sep 1999;121(3):190-4
Shambaugh GE, Glasscock ME. Canal wall up
mastidectomy. Surgery of the Ear.
Shambaugh GE, Glasscock ME: open cavity mastoid
operation Surgery of the Ear.
Scott brown 6th edition anatomy of the middle ear
Bluestone CD. Acute and chronic mastoiditis and chronic
suppurative otitis media. In: Feigin RD, editor, Wald ER,
Dashefsky B, guest editors. Seminars in pediatric infectious
diseases. Vol 9. Philadelphia: WB Saunders; 1998;9:12–26.