Atticotmy

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Atticotmy

  1. 1. Atticotomy Middle ear anatomySurgical management of cholesteatoma: The two main options and the third way – atticotomy/limited mastoidectomy T.P. Nikolopoulos *, P. GerbesiotisInternational Journal of Pediatric Otorhinolaryngology 73 (2009) 1222–1227
  2. 2. Middle ear anatomy
  3. 3. Posterior mesotympanium
  4. 4. Prussak’s space
  5. 5. Tos• TOS Pars flaccida – Grade I - retraction towards malleus – Grade II – retraction onto malleus – Grade III – retraction onto malleus neck / beyond annulus fundus visualised no erosion – Grade IV – beyond annulus fundus visualised with erosion – Grade V – fundus not visualised = epitympanic cholesteatoma
  6. 6. Sade• Sade – Grade 1 – slightly retracted TM without adherence to ossicles – Grade 2 – adherence of TM to ossicles – Grade 3 – TM draping over promontory without adhering to it – Grade 4 – adherent to promontory – Grade 5 (added later) – perforated TM in same position as grade 4
  7. 7. Attic cholesteatoma
  8. 8. Atticotomy• Definition• Indication/Contraindication• Pre-Op consult• Surgical procedure• Complication• Post op
  9. 9. Atticotomy• Limited cholesteatoma (ME,Epitympanum)• Entails removal of the scutum for access to limited attic disease• Aditus obliterated• Scutal defect can be reconstructed (cartilage) to decrease possibility of recurrent cholesteatoma
  10. 10. Indication/contraindicaiton• small, localised attic cholesteatoma / retraction pocket +/- OCR• Patients with medical conditions precluding GA
  11. 11. Pre-op Counseling - Risks of Surgery• Facial paralysis• Vertigo• Tinnitus• Hearing loss• Staged procedure• Need for long term follow-up and routine aural toilet
  12. 12. Surgical procedure
  13. 13. Temporalis fascia graft
  14. 14. complication• Perioperative complications
 Facial nerve injury
 Sensorineural hearing loss
 Dysgeusia
 Brain herniation
 Cerebrospinal fluid leakage
 Bleeding• Late complications Postoperative infection
 Posterior canal breakdown
 Perichondritis
 Mucosalization of mastoid bowl
 Stenosisof external canal Residual disease/recurrence
  15. 15. Bondy procedure• Attic and mastoid disease• Lateral to ossicles, not in middle ear space• Cholesteatoma marsupalised• Requires good eustachian tube function and intact pars tensa

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