Surgical approach to middle ear,mastoid mamoon

2. • The three most commonly used surgical approaches to the middle ear and
mastoid are:
• Transcanal,
• Endaural,
• Postaural

3. • The decision as to perform any of these approaches
should be based on preoperative evaluation .
• The expected extent of surgery, the necessity of
opening the mastoid, the given anatomical findings,
all have to be considered.

5. • Not commonly used in children
• Contraindicated in diffuse or localized otitis externa
• Used when the mesotympanum and
hypotympanum are the surgical sites

6. Indications
• Tympanoplasty
• Ossiculoplasty
• stapedectomy
• Removal of glomus tympanicum
• Exploratory tympanotomy
• Second look” tympanotomy
• Repair of round window after rupture

7. Preparation
• Done G/A and L/A
• Wax is cleared from EAC
• Hairs clipped from EAC
• If a temporalis graft is to be used, a small
portion of hair is shaved just above the
pinna.

8. • position
• Canal is cleaned with pyodine and
draped applied
• Canal is cleard by genlte suction

9. LA (lignocain with adrenalin)
Procedure

10. • Incision is made

11. • Reflection of the tympanomeatal flap

12. • The superior portion of the tympanomeatal flap is completed
• Curettage of the posterosuperior canal wall scutum

13. • The tympanomeatal flap is completed when the posterior edge of the
long process of the malleus, the long process of the incus, the stapes,
the stapedius tendon, and the round window are visible, and the flap is
reflected anteriorly without tension

14. Closure of wound
• Flap is replaced
• Incision line sealed with gelatin
sponge
• Light pack in EAC placed

15. • Commonly used in infants and young children
• Accessibility to epitympanum and postero-superior part
of mesotympanum
• Temporalis fascia and tragal cartillage graft can be
easily obtained
• faster and less traumatic compared to the postaural
approach
• Difficult to gain access to mastoid tip cells

16. • Tympanoplasty
• Atticotomy and atticoantrostomy
• Congenital and acquired cholesteatoma in the epitympanum
• meatal stenosis
• Excision of osteomas and exostoses of ear canal
• Large tympanic membrane perforation
• Modified radical mastoidectomy
Indications

17. Anaesthesia
• additional injections are placed in the
incisura of the pinna

18. The incision

19. Flap elevation

20. Middle ear cavity opened

21. • Exposure of mastoid and temporalis fascia

22. • Exposure of mastoid antrum

23. • Exposure of attic and mastoid bowl

24. • Atticotomy

25. Closure of the wound
• Bipp pack is commonly used
• Vicryl stitches to approximate edges
• Skin is closed with silk
• Firm mastoid bandage is applied

26. • frequently used in children.
• fascia graft can be readily obtained
from the temporalis muscle
• Excellent approach to mastoid

27. • Cortical mastoidectomy
• MRM and radical mastoidectomy
• Combined approach tympanoplasty
• Cochlear implantation
• Facial nerve surgery
• Translabyrinthine removal of acoustic tumour
• Retrolabyrinthine approach to CP angle
Indications

28. Indications
• Carcinoma of the middle ear
• Extensive glomus jugulare tumours
• Rarely ,thrombophlibitis arising from lateral sinus
thrombosis
• Some cases of congenital atresia

29. • The anesthesia is the same as that described
for the transcanal approach,
• Additional injection sites are required in the
postauricular area

30. Incision
• A transcanal incision is made from the 6 to 12 o’clock
position about one third of the distance from the
annulus to the meatus to create a tympanomeatal flap

31. INCISION

32. INCISION IN CHILDREN

33. Elevation of Skin Flap

34. Incising Periosteum

35. Elevation of Periosteal Flap

37. Mac Ewen’s Triangle

39. Closure of the wound
• Periosteal edges are approximated
• Skin closed with interrupted silk
• Firm mastoid bandage applied

40. Facial nerve paralysis
Acute SOM
vertigo
TM perforation
Dead ear
Distortion or lost of taste
Persistent bleeding
Perichondritis

41. Dead ear
Persistent vertigo
Persistent perforation
Meatal stenosis