Hammer and gouge mastoidectomy for acute mastoiditis - Vula ...
Hammer and gouge mastoidectomy for acute mastoiditis - Vula ...
Hammer and gouge mastoidectomy for acute mastoiditis - Vula ...
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InstrumentationGouges <strong>and</strong> chisels should be keptextremely sharp, so as to ensure controlledbone resection. Blunt instrumentationrequires undue <strong>for</strong>ce to be applied, <strong>and</strong><strong>gouge</strong>s/chisels may slip off bone <strong>and</strong>plunge <strong>and</strong> damage critical structures suchas brain, lateral sinus, facial nerve, innerear, <strong>and</strong> carotid artery. For the bone workthe surgeon requires the following:Curved periosteal elevatorMalletThree <strong>gouge</strong>s: Large, medium, smallFlat chiselCurettesRongeurs/bone nibblers (small,medium <strong>and</strong> large)Retractors (2), ideally self-retractingCanal elevator/McDonalds dissectorBlunt probeMicroinstruments: Curved needle,Plester knife, sickle knife, curetteSuction tipsPosition of PatientThe patient is laid supine with the headturned towards the normal ear.Position of Surgeon <strong>and</strong> AssistantsThe surgeon st<strong>and</strong>s on the side of theaffected ear. Two assistants are stationedon the other side, facing the surgeon. The1 st assistant is nearest to the head. The 2 ndassistant is exactly opposite the surgeon.Operative FieldThe mastoid, auricle, <strong>and</strong> preauricularregions are extensively swabbed withtincture of iodine. The patient is covered tothe neck with a sterile sheet. The operativefield is isolated by four towels. Over themis placed a fenestrated sheet, the orifice ofwhich encircles the auricle <strong>and</strong> mastoid.AntibioticsNo antibiotics are required <strong>for</strong><strong>mastoidectomy</strong> <strong>for</strong> uncomplicatedcholesteatoma, other than when there issecondary infection (<strong>mastoiditis</strong>).BIPP PasteBIPP Paste can be prepared <strong>and</strong> used toimpregnate ribbon gauze. This can be usedto pack the mastoid cavity or ear canal, <strong>and</strong>because of its antiseptic properties, may beleft in place <strong>for</strong> a few weeks.Bismuth subnitrate 20% w/w, iodo<strong>for</strong>m40% w/w, paraffin liquid 40% w/w (w/w =weight <strong>for</strong> weight)Figure 1: Instruments <strong>for</strong> bone work2