Procedures Surgeries - Mastoidectomy

What is Mastoidectomy?

Mastoidectomy is a surgery performed to eradicate the disease present in the middle ear cleft, the mastoid air cells and the attic. The extent and type of disease indicates the type of mastoidectomy required.

What are the types for mastoidectomy?

A) Simple mastoidectomy:

It involves removal of the disease from the mastoid antrum or the air cell system with intact bony external canal wall without disturbing the middle ear contents.

Indications:

  1. Coalescent mastoiditis
  2. Unresolving acute otitis media
  3. As an approach to:
  4. Facial nerve decompression
  5. Endolymphatic sac decompression
  6. Labyrinthectomy

B) Radical mastoidectomy:

The mastoid antrum and air cell system, aditus ad antrum, attic and middle ear are converted into a common cavity. The eustachian tube opening is plugged by cartilage and all the remnants of tympanic membrane, malleus and incus are removed, except the stapes foot plate if healthy.

Indications:

  1. Extensive cholesteatoma with evidence of complications
  2. Recurrent cholesteatoma
  3. Malignancy of mastoid bone or middle ear
  4. Glomus tumours
  5. Tuberculous mastoiditis

C) Bondy's modified radical mastoidectomy:

This surgery is similar to radial mastoidectomy but the ossicular chain, the mucosa over promontory, if healthy, is kept intact thus preserving as much of the hearing as possible.

Indications: Cholesteatoma confined to attic and antrum.

What are the complications of mastoidectomy?

Possible complications of mastoidectomy are:

  1. Facial paralysis
  2. Perichondritis
  3. Labyrinthitis
  4. Injury to dura or lateral sinus
  5. Discharging cavity.
  6. Permanent sensorineural hearing loss.

However with the advent of good microscopes and instrumentation the chances of intraoperative mastoidectomy complication are reduced.



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