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
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Secrets of success in Tympanomastoid surgeries
1. Secrets to Success in
Tympanomastoid surgeries.
Skip Introduction
Dr. Prahlada N B, MBBS, MS (PGIMER,
Chandigarh)
Karnataka ENT Hospital & Research Center,
Chitradurga, Karnataka, India. 1
4. I am no Guru!
First of all let me make it clear, I
am no Guru!
Everyone is capable of lot of things
You are a treasure trove of knowledge,
skill and ideas
You just have to wake up the Genius
within you!
I am only trying to un-ravel the potential
within you!
4
5. First Do No Harm
Making of a
Neurosurgeon
Story of
Dr. Kenyon Rainer
5
6. Problem in India
7% of Indians have Ear Problems
90% of these are Middle ear infection
35% have bilateral problems
11 Crore ears need tympanoplasty !
22,000 Cases/ENT Surgeon
6
8. Success
What makes a person successful
How do we recognize success
T some people success means “
o
–W ealth, Recognition, Good
Health, Good family, H appiness,
Satisfaction, Peace of Mind.
“Success is
subjective”
8
9. “ Success is the progressive realization
of a worthy goal.”
Success is the Progressive Realization of a Worthy Goal
Earl Nightingale
E Nightingale
arl
9
10. “ Progressive”
Success is a journey, not a destination
We never arrive
After we reach one goal, we go on to the
next and the next and the……..
……………………………………… 10
11. Goals
Goals are a must
Goals give you direction for your life
Life without goals is like a boat without a
sailor
When you make goals, make big goals
Write down your goals and read them out
aloud everyday
11
12. S.M.A.R.T GOALS
SPECIFIC
MEASURABL
E
ACHEIVABLE
REALISTIC
12
13. MBO
Cost effective
Time saving
Maximum results
Least number of complications
TQM – TOTAL QUALITY
MANAGEMENT
13
21. Ask
If you don’t know, Ask !
If you are unsatisfied, Ask !
If you want to accomplish a goal, Ask !
If you are confused, for good counsel, Ask !
If you desire to communicate, Ask !
When you expect good things in life, Ask !
21
22. Step 1 :
Selection of Cases
Know when not to operate :
“Many times, to realize on which
patients one should not operate is what
makes a surgeon’s final results shine
above those of others”.
Hamed Sajjadi, MD, FACS.
OTOLARYNGOLOGIC CLINICS OF NORTH
AMERICA
Volume 32. Number 3. June 1999. 22
23. Step 2 :
Good Anesthesia
Use GA/LA judiciously. Don’t be
dogmatic.
Infiltrate LA even when you operate under
GA.
Variation of anesthetists.
– Superficial type
– Gas man
– Freelancer
23
24. Bevel of the needle should be
towards the bone.
Video
Click video button below.
And click play button in Quite time movie player.
Open movie file anesthesia with Quick Time
Movie Player.
24
26. Step 3 :
Approach/Technique
“Every intra-op surgical decision needs to be
custom-made to the individual patient’s needs
and the surgeon’s capabilities and facilities.
Surgeon’s must avoid fitting their patients to their
surgical techniques.
On the contrary, we must adjust our surgical
choices to fit each patient's situation needs. “
26
27. Step 3 :
Approach/Technique
Multiple choices may have to be
considered before each patient is offered
a particular type of surgery, and surgeons
need to be prepared to change their
techniques accordingly and competently.
Hamed Sajjadi, MD, FACS.
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA
AMERIC
Volume 32. Number 3. June 1999.
27
29. How I do it
Trans-canal approach
– Post-traumatic perforation - < 3 months
29
30. How I do it
Endomeatal approach – Wide canal
– Post-traumatic perforation - > 3 months
– Central perforation – other aetiology
– < 3 months.
30
31. How I do it
End-aural approach – Narrow Canal
– Posterior Central perforation
– When Cortical mastoidectomy is not planned
31
32. How I do it
End-aural incsions for Koerner’s flap/Post-
aural approach
– Anterior perforation/Anterior bony overhang
– Large perforation/Subtotal/total perofrations
– When Cortical mastoidectomy is
contemplated
32
33. Step 4 :
Incision Techniques
End-aural incisions
Video
Watch “approach” video with Quick Time
Movie Player.
33
34. Making End-aural incisions.
The Modified Lempert's end-aural incision
consists of 3 parts.
– Part 1 : Posterior canal wall incision.
– Part 2 : Superior canal wall incision.
– Part 3 : Inferior canal wall or floor incision.
34
46. Technique of Cortical
Mastoidectomy
Canalplasty first
Mark cortical mastoidectomy land mark
initially
Antrum lies postero-superior to Spine of
Henle, not posterior
Do Cortical mastoidectomy/Not just
antrotomy
Don’t burr hole !?
46
48. Step 8 :
Ossiculoplasty
Check for mobility/round window reflex.
Gentle is the word.
Excise tympanoslerotic plaques
Reconstruction with Autologous
Incus/Conchal cartilage
48
49. Step 8 :
Grafting technique
Underlay
Interlay
Excise the remnants of TM and Fibours
annulus completely
– Total/Subtotal perforations
– Epithelium has grown inside
– Mucosa has grown outside
49
50. Step 8 :
Grafting technique
Medial / Lateral to malleus ?
Medial to malleus :
– Foreshortened malleus
– Malleus adherent to promontary
Lateral to malleus :
– All other situations.
50
51. Step 8 :
Grafting technique
Technique of Medializing the graft medial
to the malleus.
51
52. Malleus : Foreshortened/
Adherent to promontory
Never cut tip of the malleus.
Epithelium is never adherent to malleus
/only fibrous layer can.
Length of the malleus is important
Cut the tensor tympani tendon to increase
the middle ear space
52
53. Step 9 :
Stabilizing the graft and flaps
Prevent anterior blunting.
Pack Middle ear and External auditory
canal properly.
Prevent haematoma beneath
Tympanomeatal/Koerner’s flaps.
Prevent narrowing of EAC.
53
54. Step 10 :
Post-op Care
Record the mistakes
Analyze your results
Improve on them
Failures – Do free revisions !
54
55. Every success story is also a story of great failure
“Failure is the Highway to
Success”
55
56. “If you want to succeed, double your failure rate”
T W
om atson Sr., of IBM
56
57. Life is full of Compromises
Lifeis full of happiness & sorrow
Good and B ad
Dark Spots and B right spots
57
59. Manage you time!
Father of Scientific Management
Frederick Taylor (1856-1915)
Taylorism
59
60. Our Vision for the Year
2007-08
To achieve $ 231 million in revenue.
To be among the top 10% in our business in terms of profit
after tax (PAT) and return on investment (ROI).
To be one of the top 20 globally admired companies in our
industry.
To give a significant portion of our PAT to support primary
education.
60