Hammer and gouge mastoidectomy for acute mastoiditis - Vula ...

CERVICAL SEPSISLateral sinus thrombosis may becomplicated by extension of sepsis downthe internal jugular vein into the neck(Figure 29).gouge is usually very limited and quicklysettles. Bleeding can usually be controlledby packing off the sinus with surgical. Ifthe hemorrhage persists or threatens torecur, the cavity is firmly packed withiodoform impregnated ribbon gauze, theend of which exits from the wound next tothe drain. It is removed a few days later.Exposure of Meninges: Exposure of themeninges is not a concern. No change inmanagement is required.Tear of Meninges with CerebrospinalFluid leak: A tear of the meninges issimply repaired with silk or other suture. Ifnecessary, muscle or fascia can be used toaugment the repair.Figure 29: Extension of sepsis downinternal jugular veinInfection of the mastoid may also lead tothe formation of cervical abscesses whichvary according to their form ofexteriorization:Abscess of nape of neck inposteroinferior mastoiditisSubsternomastoid abscess (Bezold’sabscess)Internal aspect of mastoid tip, alongdigastric muscleDeep jugulodigastric cervical abscess(mastoiditis of Mouret)INTRAOPERATIVE INCIDENTSAccidental Opening of the Lateral Sinusor Mastoid VeinOpening of the lateral sinus is more severeif accidentally produced with a rongeur.The use of this instrument is thereforediscouraged in the posterior region of themastoid. Injury to the venous wall with theOpening of lateral or posteriorsemicircular canal: The canal is simplycovered with fascia, which is held in placeby muscle or gauze packingANTROTOMY IN THE INFANTAntrotomy is the surgical opening of theantrum, which is the principal mastoidcavity in the infant. Antrum is fullydeveloped, as opposed to the mastoid thatis not fully developed. The facial nerve ismore superficial at the mastoid tip than inthe adult.Indications include: Early acute mastoiditisunresponsive to antibiotics; complicatedmastoiditis; subperiosteal abscess;intracranial complications (meningitis,abscess); facial paralysis secondary tomastoiditis; suspected tuberculousmastoiditis (remove sequestrum and obtaintissue for diagnosis of TB; and mastoiditissecondary to cholesteatoma13