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.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
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.
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 .
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.
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 .
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
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The degree of pneumatization and the position of septae in the sphenoid sinus are highly variable.
In the majority of cases the pituitary fossa will form a bulge in the posterior or posterosuperior region of the sphenoid and is easily identifiable with the operating endoscope.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Open cavity procedures can be broadly defined
as those requiring the removal of the posterior
wall of the external auditory canal.
These procedures are identified by many
names—canal wall down mastoidectomy,
modified radical mastoidectomy, radical
mastoidectomy, and the Bondy mastoidectomy—
depending on how the middle ear and the
disease are managed
3. The purpose of open cavity procedures is to
exteriorize the mastoid cavity for future monitoring
of recurrent cholesteatoma, provide drainage for
unresectable temporal bone infection, and,
occasionally, provide exposure for difficult-to-
access areas of the temporal bone.
4. HISTORICAL NOTES
In 1873, Von Tröltsch was the first surgeon to
suggest that Schwartze’s simple mastoidectomy
technique needed to be modified to reduce
persistent otorrhea after initial surgery.
He had observed that remnants of cholesteatoma
in the attic, antrum, or mastoid process would
invariably result in chronic drainage.
5. Von Bergmann applied the term “radical” to any
case in which the posterior and superior bony
canal walls were removed to develop an open
cavity.
6. . In 1890, Zaufal described in detail the technique
of the radical mastoidectomy to eradicate disease
in the middle ear and mastoid. This operation
converted the attic, antrum, mastoid process,
tympanum, and external auditory canal into a
common “radical cavity” that could be inspected
and cleaned for the rest of the patient’s life.
7. Hearing, however, was at times quite good in
patients who presented with cholesteatoma
confined to the attic in which the pars tensa of the
tympanic membrane was intact. Körner
recognized this situation in 1899 and suggested
that the tympanic membrane and ossicles could
be left in place during radical operations in certain
cases of chronic otitis.
8. In 1910, Bondy
described the
indications and
technique for a
modification of the
radical operation in
cases involving a pars
flaccida perforation with
an intact pars tensa.
In this technique, the
superior osseous
meatal wall and a
portion of the posterior
osseous meatal wall
were removed without
disturbing the intact
tympanic membrane
(except for the attic
9. This technique thus
exteriorized the attic
and antral
cholesteatoma into a
permanently open
“modified radical”
cavity that could be
cleaned through the
external meatus
without further
destroying hearing.
10. INDICATIONS FOR THE CLASSIC RADICAL
MASTOID OPERATION
1. Unresectable cholesteatoma extending down
the eustachian tube or into the petrous apex
2. Promontory cochlear fistula caused by
cholesteatoma
3. Chronic perilabyrinthine osteitis or
cholesteatoma that cannot be removed and must
be cleaned or inspected periodically
4. Resection of temporal bone neoplasms with
periodic monitoring
11. INDICATIONS FOR MODIFIED RADICAL
MASTOIDECTOMY
Modified radical mastoidectomy is an effective
method to manage cholesteatoma in a single-
stage approach
Absolute indications :
unresectable disease,
an unreconstructable posterior canal wall,
failure of a first-stage canal wall up procedure
because of poor eustachian tube function,
and inadequate patient follow-up.
12. The relative indications
disease in an only hearing ear or in a dead ear,
medical illness, severe otologic or central nervous
system complications, and neoplasms
is poor eustachian tube function.
13. Conservative management of
cholesteatoma
Conservative management of cholesteatoma can
be attempted when the attic defect is large and
the cholesteatoma sac shallow, allowing the
accumulated desquamated debris to be removed
by microdébridement and suction.
14. Conservative management is
contraindicated
1. Radiographic evidence of an enlarged,
smoothwalled antrum indicates a large
cholesteatoma cavity.
2. Otorrhea persists after several cleanings.
3. A very small attic perforation makes cleaning
painful, difficult, and unsatisfactory.
4. Cholesteatoma is observed behind the pars
tensa.
15. 5. There are symptoms or signs of erosion of
vital structures such as the fallopian canal,
semicircular canals, cochlea, or dura.
6. Hearing loss, either conductive or
sensorineural, indicating progression of
cholesteatoma.
7. The patient is uncooperative or is
geographically unable to return for necessary
management.
16. CONTRAINDICATIONS FOR THE
OPEN CAVITY MASTOID
OPERATION
cases of chronic otitis media without
cholesteatoma
cases of acute otitis media with coalescent
mastoiditis, persistent secretory otitis media, or
chronic allergic otitis media.
. Relative contraindications for open cavity
procedures include wide exposure of the sigmoid
sinus, dura, and the facial nerve caused by
aggressive disease.
17. RADICAL MASTOIDECTOMY AND BONDY
MODIFIED RADICAL MASTOIDECTOMY
The techniques of the radical mastoidectomy and
the Bondy radical mastoidectomy are presented
for historical interest and perspective.
The objective of these procedures was to remove
safely all bone-invading disease; create an
accessible, exteriorized cavity for lifelong cleaning
and care; and promote epithelialization of the
cavity with healthy skin.
Hearing improvement was of secondary
importance.
18. The radical and Bondy operations began with
exposure of the attic and antrum, followed by
removal of the superior and posterior canal walls.
By performing the “inside-out” mastoidectomy, the
resultant cavity was smaller than if a complete
mastoidectomy with tympanoplasty were
performed.
However, as a result of this approach, peripheral
air cells were isolated from the eustachian tube.
If the mucosa continued to produce mucus, it
discharged into the mastoid cavity.
19. All matrix is removed, with the
following exceptions:
1. Matrix firmly adherent to exposed dura or
sigmoid sinus may be left rather than risk injury to
these structures.
2. Matrix over a fistula of a semicircular canal
may be left to avoid postoperative serous
labyrinthitis.
3. Matrix firmly attached to exposed facial nerve
may be left
4. Matrix extending into the mesotympanum and
covering the stapes footplate may be left
20. Bone Removal beyond
Cholesteatoma
Remembering that chronic otorrhea is the result
of infected epidermal debris in the cholesteatoma
sac, in most cases, evacuation of the sac,
removal of matrix (epithelial lining), and curettage
of softened osteitic bone adjacent to the matrix
suffice to control the disease. The surgeon needs
to exercise prudent judgment with regard to
mastoid cells outside the cholesteatoma sac.
These cells may be infected and osteitic
(softened), with granulations requiring removal,
but in many cases, mastoid cells are intact and
need not be removed.
21. Taking Down the Bridge and the Facial Ridge
The remaining superior osseous meatal wall
bridging the notch of Rivinus is removed in small
bites
With a small (000) curet, always working outward
away from the fallopian canal and facial nerve,
the anterior and posterior spines of the notch of
Rivinus, composing the anterior and posterior
buttresses of the bridge, are taken down.
22.
23.
24.
25.
26. Wherever cholesteatoma envelops or extends
onto the medial surface of the malleus head or
incus, these ossicles must be removed.
When cholesteatoma matrix lies against and
lateral to these ossicles, the matrix may be left or
carefully removed and the ossicles left
undisturbed.
When the long process of the incus is absent and
matrix lies against the mobile stapes head, with
excellent hearing producing nature’s
myringostapediopexy, this portion of the matrix is
left undisturbed.
27. The step in the radical
or Bondy operations
most often
accomplished poorly
is taking down the
posterior osseous
meatal wall, which,
deeper in, houses the
posterior bend and
vertical facial nerve
and thus is called the
facial ridge.
28. The approximate
position of the facial
nerve is located by
three usually
dependable
landmarks:
the bony horizontal
semicircular canal
above, the
tympanomastoid
suture in the posterior
meatal wall, and the
digastric ridge in the
29. The bony facial ridge is taken down slowly and
carefully with a drill or curet, working under the
operating microscope, always parallel to and
never across the direction of the facial nerve.
A pinkish color and bleeding are encountered
when the facial nerve is approached. It is better
not to expose the nerve unnecessarily
30. MODIFIED RADICAL
MASTOIDECTOMY
Modified radical mastoidectomy, also known as
complete mastoidectomy and tympanoplasty,
complete removal of the posterior canal wall with
sealing of the middle ear space to avoid chronic
drainage from exposed mucous membrane
31. The modification of the radical procedure (ie,
adding the technique of tympanoplasty)
potentially eliminates the expected intermittent
discharge from the middle ear mucosa. Hearing, it
should be noted, is a secondary consideration of
the modified radical procedure.
32. Preoperative Assessment
The decision to perform a modified radical
mastoidectomy rather than a staged intact canal
wall approach depends on the extent and location
of the disease, previous surgery, eustachian tube
function and patient age, medical condition, and
aftercare preference.
33. Extensive destruction of the posterior canal wall
with obvious cholesteatoma invading the mastoid
indicates the need for modified radical
mastoidectomy.
Active suppuration should be controlled prior to
surgery whenever possible.
Acetic acid (1.5% solution) irrigations followed by
antibiotic otic drops should be instituted for
several weeks prior to surgery
34. Meatoplasty
One percent lidocaine with 1:100,000 epinephrine
is infiltrated into the conchal bowl.
The entire posterior aspect of the conchal bowl is
exposed using sharp dissection with an iris
scissors through the fibrous periosteum and soft
tissue.
With a finger in the conchal bowl, a semilunar
incision is made into the cartilage posteriorly until
the knife tip is felt through the anterior skin.
This crescent-shaped cartilage measures about
1.5 2cm
35. A Körner flap is now
developed by making
incisions through the
external auditory canal
skin.
An inferior incision is
begun in the inferior
canal at 6 o’clock,
carried into the conchal
bowl, and curved
around the inferior
margin of the bowl.
A superior incision is
made at 12 o’clock and
carried between the
tragus and the anterior
helix.
36. These incisions create
a long (vascular strip)
flap that is based in
the posterosuperior
aspect of the conchal
bowl and will
constitute the back
wall of the mastoid
cavity
37. Postoperative Care
At the first postoperative visit, any area that has
not been grafted is covered by a layer of
granulation tissue. Exuberant granulation tissue
should be débrided and treated with silver nitrate.
The granulation tissue should then be painted
with 2% gentian violet and the patient instructed
to use antibiotic otic drops two or three times per
day until the next (at 2 to 3 weeks) visit.
38. Drainage decreases with ensuing visits as re-
epithelialization occurs. As epithelialization
progresses, acetic acid irrigations can replace the
use of antibiotic otic drops.
Once the cavity is healed, the patient should
return for a yearly visit and is given full water
sport privileges.
39. COMPLICATIONS OF OPEN CAVITY
PROCEDURES
deafness or further hearing loss, facial paralysis,
vestibular symptoms, cerebrospinal fluid leak,
infection, and recurrent cholesteatoma or
drainage.
40. Facial nerve paralysis is the most common major
complication associated with open cavity
procedures.
The second most common complication of open
cavity procedures is wound infection.
This infection usually results in perichondritis of
the auricle, manifested by a painful, swollen
auricle with copious discharge. Pseudomonas
aeruginosa is the causative organism.
41. A “chocolate” or mucous retention cyst can occur
in a healed mastoid cavity as a result of a
collection of serum within a mucous membrane–
lined pocket.
42. Cholesteatoma recurrence in open cavity
procedures occurs is usually caused by
inaccessible disease or a remnant of matrix that
was amputated at the time of surgery
43. Recurrent aural drainage from a previously
healed and dry cavity is usually the result of poor
aural toilet.
44. conclusion
Open cavity mastoid procedures are indicated
when canal wall up procedures are inadequate to
control disease.
The vast majority of these procedures will result
in a modified radical mastoidectomy.
Identification of the facial nerve is critical in this
procedure.
Lowering of the facial ridge to the level of the
facial nerve and development of a large external
auditory meatus are mandatory for successful
outcome.
Long-term postoperative care is minimal, with