MASTOIDECTOMY

21M064
 OBJECTIVES

• INTRO
• SURGICAL ANAT
• TYPES
• INDICATIONS
• TECHNIQUES
• COMPLICATIONS
• CONCLUSION
 INTRODUCTION
M stoidectomy is surgic l procedure which opens up the
m stoid c vity,
Cle ns up the infected ir cells nd improves middle e r
ventil tion by widening the ditus .
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 Surgical Anatomy:
The temporal bone connects to the parietal, occipital,
zygomatic, and sphenoid bones. It is a pyramidal bone with the apex pointing in the
anteromedial direction.
The temporal bone consists of four embryologically distinct
components: squamous, petrous, tympanic , mastoid parts
 -The mastoid parts is a bulbous bony
structure
-Its shaped by the expansion of air eld spaces
within.the central air cell is called the antrum
-Temporal line estimates the location of
middle fossa oor

Suprameatal spine of Henle= Is a small

bony protuberance found at the
posterior superior lateral edge of the ear
canal, which marks the level of the
antrum of the mastoid

Posterior to it is a group o small holes

(Cribriform area).Lies within Macewen
triangle.
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 Macewen's triangle=
Is a surgical surface marking for mastoid antrum
Borders
Superior: Temporal line.
Anterior: Postero-superior margin of bony EAC.
Posterior: Tangent drawn to the mid-point of
posterior wall of EAC.
The mastoid antrum lie
12.5-15mm deep to the triangle.

• Anterior buttress is the point at which the posterior bony

canal wall meets the tegmen.
• Posterior buttress marks the meeting of the posterior canal
wall andthe oor of the EAC
lateral to facial nerve. •
• Removal of posterior buttress- oor of the EAC slops
o gently into the mastoid tip.
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• Citelli's angle (Sinodural angle)- is an angle
between the sigmoid sinus and middle fossa dural
plate.
• Solid angle is an area where three bony
semicircular canals meet.
• Trautmann's triangle is bounded by bony labyrinth
(solid angle) anteriorly, sigmoid sinus posteriorly and
dura superiorly.

• Donaldson's line is a line passing through the

horizontal semicircular canal and bisects the
posterior semicircular canal.This line is a
landmark for the endolymphatic sac.
 CORTICAL MASTOIDECTOMY:
• Cortic l m stoidectomy k simple/complex m stoidectomy or
Schw rtz oper tion, Is complete exenter tion of ll ccessible
m stoid ir cells nd converting them into single c vity. Posterior
me t l w ll is left int ct. Middle e r structures re not disturbed.
• Indic tions= 1) cute choleste tom m stoiditis
2) incompletely resolved cute OM with reservoir sign
3)m sked m stoiditis
4) ppro ch to- endolymph tic surgery,
decompression of f ci l nerve, tr nsl byrinthine /
retrol byrinthine procedures for coustic
neurom .
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 • GA used
• P tient lies supine with f
ce turned to one side
nd the e r to be oper ted uppermost.
• Steps of oper tion=
1. Incision ( C sh ped)
2. Exposure to l ter l surf ce of m stoid nd
m cew ns tri ngle.
3. Remov l of m stoid cortex nd exposure of
ntrum.
4. Remov l of m stoid ir cells
5. Remov l of m stoid tip nd inishing the
c vity
6. Closure of wound.
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• Post-op c re=. 1) ntibiotics for one week
2)dr in, if puts removed within 24-48h nd sterile dressing done.
3)Stitches re removed on the sixth d y.

• Complic tion=
1) injury to f ci l nerve
2)disloc tion of incus
3)injury to horizont l SCC (pt will h ve post op giddiness nd nyst gmus
4)injury to sigmoid sinus with profuse bleeding.
5)injury to dur of middle cr ni l foss .
6)post-op wound infection nd wound bre kdown
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 RADICAL MASTOIDECTOMY:
• Its a procedure to eradicate disease from the middle ear and
mastoid without any attempt to construct hearing.
• Posterior meatal wall is removed, the entire area of
ME,attic,antrum & mastoid is converted to single cavity.
• Indication= 1)when all cholesteatoma cant be safely removed.
2)as an approach to petrous apex
3)removal of gloms tumour
4) carcinoma middle ear
• GA given . LA can be used in selected cases.
• steps= 1)incision
2)retraction of soft tissues and exposure of mastoid area.
3)removal of bone and exposure of attic and antrum.
4)removal of bridge and the buttresses.
5)lowering the facial ridge.
6)toilet of middle ear.
7)Inspection of cavity and irrigation
8)meatoplasty Postaural Endaural
9)obliteration of cavity
10) closure of wound
• Post op care= 1)dressing- rst on 3rd or 4th day,second on 6th
or 7th day.
2)antibiotics
3)cavity care
Complications= 1)facial paralysis
2)perichondritis of pinna
3)injury to dure or sigmoid sinus
4) labrynthitis, if stapes gets dislodged
5)severe conductive deafness.
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 MODIFIED RADICAL MASTOIDECTOMY:
• Its a modi cation of radical mastoidectomy where as much of
the hearing mechanism as possible is preserved. The disease
process which is often localized to attic & antrum is removed
and whole are fully exteriorised into meatus by removal of
posterior meatal and lateral attic wall.
• Indication= 1) cholesteatoma
2) localised COM
• GA/LA can be used
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• Steps= 1)incision
2) & 3) same as in radical mastoidectomy
4)removal of diseased tissue
5)facial ridge is lowered
6)mastoid cavity is smoothened
7)reconstruction of hearing mechanism
8) meatoplasty and closure of wound
• Post-op care & complications same as radical mastoidectomy
CONTRAINDICATIONS=

1)Chronic otitis media without cholesteatoma

2)Acute otitis media with coalescent mastoiditis,
persistent secretory otitis media, or
3)Chronic allergic otitis media.
4)Tuberculous otitis media.
 COMBINED APPROACH TYMPANOPLASTY (CAT)/
CLASSIC INTACT CANAL WALL MASTOIDECTOMY:

-CAT consists of a large mastoidectomy with an intact but thin bony ear canal wall and
posterior
-atticotympanotomy. The intact canal wall technique is performed in two
-stages. 1 The rst operation is performed to remove all
cholesteatoma and repair the tympanic membrane.

-Six months later, the second operation is performed to inspect the mastoid and middle
ear for residual or recurrent cholesteatoma and to improve hearing by
ossicular reconstruction.
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• ATTICOANTROTOMY= is an extension of the atticotomy in a posterior direction
through the transmeatal route, in which lateral attic and aditus walls are removed, and
the antrum is entered. It can be performed through the transcortical route,but is usuall
performed through a transmeatal route.

• BONDY'S OPERATION =
An atticoantrotomy is called as Bondy's operation if the tympanic cavity is not entered. If
the tympanic cavity is entered, it is NOT described as BONDY'S operation but as an
atticoantrotomy orconservative radical operation.
 Reference
Dhingr seventh edition
https://www.slidesh re.net/slideshow/m stoidectomy-50142145/50142145
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