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Canal Wall Up Mastoidectomy
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
9 sections · 120 slides
Overview and Historical Development
- Tympanomastoidectomy: definition and scope
- Origins of cortical mastoidectomy
- Radical and modified radical mastoidectomy
- Antibiotics and the emergence of canal wall up surgery
- Milestones in mastoid surgery
Pathophysiology
- Acute mastoiditis: definition
- Coalescent mastoiditis and subperiosteal abscess
- Griesinger's sign and venous complications
- Microbiology of acute mastoiditis
- Fusobacterium and Lemierre's syndrome
- Chronic otitis media: spectrum of disease
- Chronic suppurative otitis media: definition
- Distinguishing CSOM from otitis media with effusion
- Pathologic findings in CSOM
- Consequences of persistent inflammation
- Distribution of tympanosclerosis
- Proposed mechanisms of CSOM
- Risk factors and epidemiology of CSOM
Diagnosis and Medical Treatment
- Clinical history in acute mastoiditis
- Examination findings in acute mastoiditis
- Role of computed tomography in acute mastoiditis
- Intracranial complications at presentation
- Medical management of acute mastoiditis
- Indications for admission and surgery in acute mastoiditis
- Symptoms of chronic suppurative otitis media
- Otologic examination in CSOM
- Audiometric evaluation in CSOM
- Imaging in chronic suppurative otitis media
- Medical management of CSOM without cholesteatoma
- Indications for tympanomastoidectomy in CSOM
Choosing Between Canal Wall Up and Canal Wall Down
- Factors in the decision to perform CWU mastoidectomy
- Goals of CWU tympanomastoidectomy
- Whether to add mastoidectomy to tympanoplasty
- Surgical access with canal wall up and canal wall down
- Advantages of canal wall down mastoidectomy
- Disadvantages of canal wall down mastoidectomy
- The second-look procedure
- Advantages of canal wall up mastoidectomy
- Hearing outcomes by surgical approach
- Selection bias in comparative studies
- Pros and cons of CWU compared with CWD mastoidectomy
- Pros and cons of CWU compared with CWD mastoidectomy (continued)
- Intraoperative findings favouring canal wall down
- Preoperative decision to perform canal wall down
- Contraindications to CWU tympanomastoidectomy
- Extensive cholesteatoma in an only-hearing ear
- Relative indications and contraindications for CWU and CWD mastoidectomy
- Options for accessing the tympanomastoid cavity
Preoperative Management and Preparation
- Preoperative evaluation and imaging
- Anaesthesia and facial nerve monitoring
- Antisepsis and local infiltration
Operative Technique
- Canal preparation before mastoidectomy
- Postauricular incision for tympanomastoidectomy
- Postauricular incision technique
- Dissection in the loose areolar plane
- Harvest of the loose areolar fascia graft
- Periosteal incisions
- Elevation of the periosteal flap
- Exposure of the mastoid cortex
- Assessing the middle ear before drilling
- Timing of canalplasty
- Drill selection and burr technique
- Rules for safe drilling
- Irrigation during drilling
- Distorted anatomy in chronic ear surgery
- Temporal bone air cell tracts and Korner's septum
- Landmarks defining the mastoidectomy
- Identifying the middle fossa tegmen
- Identifying the sigmoid sinus and mastoid tip
- Opening the antrum through Korner's septum
- Antrotomy and completed mastoidectomy
- Attic dissection and the short process of the incus
- Access to the anterior epitympanum and the cog
- Course of the facial nerve in the surgical field
- Whether to localise the mastoid segment
- Extent of mastoid dissection
- Soft tissue dissection of cholesteatoma
- Handling granulation tissue
- Facial recess: indications and boundaries
- View of the middle ear through the facial recess
- Drilling the facial recess
- Identifying the facial and chorda tympani nerves
- Opening the facial recess
- Extended facial recess approach
Surgery for Acute Mastoiditis, Closure and Aftercare
- Goals of surgery in acute mastoiditis with abscess
- Cortical mastoidectomy technique in acute mastoiditis
- Closure of tympanomastoidectomy
- Postoperative care and follow-up
Complications
- Sources of intraoperative complications
- Bleeding from granulation tissue and bone
- Sigmoid sinus injury
- Facial nerve injury: principles
- Management of complete nerve transection
- Management of partial nerve transection
- Immediate postoperative facial paralysis
- Delayed postoperative facial paralysis
- Sensorineural hearing loss after mastoidectomy
- Postoperative vertigo
- Serous and suppurative labyrinthitis
- Early postoperative wound infection
- Dural exposure and tegmen defects
- Repair of dural defects
Summary and References
- Key points on canal wall up mastoidectomy
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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