Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.

Cortical mastoidectomy

10.074 visualizaciones

Publicado el

Cortical mastoidectomy

Publicado en: Salud y medicina
  • Dating for everyone is here: ❶❶❶ http://bit.ly/2F7hN3u ❶❶❶
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • Follow the link, new dating source: ♥♥♥ http://bit.ly/2F7hN3u ♥♥♥
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • Hello! High Quality And Affordable Essays For You. Starting at $4.99 per page - Check our website! https://vk.cc/82gJD2
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí

Cortical mastoidectomy

  1. 1. 1) Coalescent Mastoiditis and Masked Mastoiditis. 2) CSOMTTD Active Refractory to antibiotics. 3) It is the initial stage of any transmastoid surgery
  2. 2. Approach to: -Endolymphatic sac surgery. -Facial nerve decompression. -Vestibulo cochlear nerve section. -Translabyrinthine Approach for CP angle. -Cochlear implant surgery. -Combined ApproachTympanoplasty.
  3. 3. • History: • Ear discharge • Hearing loss • Fever • Pain • Facial asymmetry • Previous surgery • Medical history
  4. 4. • Otomicroscopy: • Cholesteatomas • Granulations • Helps in defining extent of the disease • Pure tone audiometry: • Establish hearing loss • Ear swab • X- ray mastoid • CBC • Coagulation profile
  5. 5. • HRCT (0.5mm cuts) • Pneumatisation • Ventilation • Tegmen tympani • Status of ossicles • Sigmoid sinus • Jugular bulb • Carotid artery • Facial nerve • Extent of the disease
  6. 6. Anesthesia  General anesthesia with endotracheal intubation • Avoid long acting muscle relaxants – facial nerve monitoring.
  7. 7. Position
  8. 8. Draping
  9. 9. Local Anaesthesia Infilteration • Lidocaine and adrenaline
  10. 10. Incision
  11. 11. Incision in children
  12. 12. Elevation of Skin Flap
  13. 13. Incising Periosteum
  14. 14. Elevation of Periosteal Flap
  15. 15. Mac Ewen’s Triangle
  16. 16. Drilling Along Temporal Line
  17. 17. Drilling Posterior to EAC
  18. 18. Drill within this triangle and work your way deeper into the mastoid
  19. 19. Identification of LSSC and Dural Plate  Thesafestwaytofindtheantrumis tofollowdura  Itisidentiefiedbychangeincolour ofthebone(dura seen shining through thin layer of bone) or change in the pitch of burr  Korner's septum is removed and antrum is entered  Drilling through the septum will allow visualization of LCC  LCC usually appears yellow in colour in floor of antrum
  20. 20. Identification of LSSC and Dural Plate
  21. 21. Identification of Incus  The burr is downsized and drilling continuous anteriorly toward the root of zygoma until incus seen in fossa incudis  Take care not touch the incus by drill
  22. 22. Identification of Sigmoid Sinus  Exentrate the air cell around the sigmoid sinus till the blue color of the sinus appeared  Follow the sinodural plate posteriorly up to the sinodural angle
  23. 23. Identification Facial Nerve • Landmarks: • Lateral semicircular canal – nerve runs anteroinferiorly • Short process of incus – nerve lies medial at the level of aditus • Diagastric ridge – nerve leaves mastoid at the anterior end
  24. 24. Identification Facial Nerve • Always drill parallel to the course of facial nerve • Use ample irrigation to prevent thermal damage to the nerve
  25. 25. Drain is placed and wound closed • Mastoid cavity is thoroughly irrigated with saline to remove bone dust • Small rubber drain placed in the lower end of incision • Skin closed
  26. 26. Drilling Tips  Hold the drill firmly but don’t press hard on the bone • Avoid keyhole surgery; work through a wide space • The tip of the drill should always be visible • Use the ‘equator’ of the burr rather than the tip • Never drill behind edges of bone • Drilling should always be parallel to structures that are to be saved with a lots of water for irrigation • If the burr is to be lengthened, switch to a diamond burr
  27. 27. Final cavity
  28. 28. Extended Cortical Mastoidectomy  INDICATED For mucosal disease without cholesteatoma, to avoid canal wall down mastoidectomy • Extend drilling anteriorly from antrum to the aditus and short process of incus • Drill in the narrow space between roof of EAC and bone over middle fossa dura. • Drill forwards to reach the root of zygoma • Open the entire attic and see the head of malleus and Incus
  29. 29. Widening of aditus
  30. 30. Posterior Tympanotomy  Drilling away of the bone between the pyramidal (mastoid) segment of the facial nerve, and the posterior bony canal and chorda tympani resulting in access to the middle ear from the mastoid.
  31. 31. Indications • To gain access to mesotympanum via cortical mastoid cavity • Cochlear implantation • Part of combined approach tympanoplasty • Cholesteatoma in mastoid bowl, and mesotympanum
  32. 32. Posterior Tympanotomy
  33. 33. Postoperative Care • Drain left for 24-48 hours • Mastoid pressure dressing for 1 day postoperatively • Keep the ear dry • Bacitracin is applied to the postauricular incision twice a day for 1 week. • Stitches removed after 1 week • Postoperative PTA is done after 4 weeks • Further follow up is after 6 months and then after 1 year
  34. 34. Complications • Persistent deafness: • Incus dislocation or removal • Sensorineural hearing loss • Facial nerve injury • Persistent infection due to residual cells • CSF leak – dura may be inadvertently opened • Vertigo • Inadvertent entry into the EAC • Hemorrhage from injury to sigmoid sinus • Postoperative wound infection .
  35. 35. Instructions to the Patient • For first 3 weeks : gentle activity e.g., housework, walking only • After 3 weeks: gentle exercise • After 4 weeks: normal gym activity Keep operation site dry

×