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

More documents

Recommendations

Info

InstrumentationGouges and chisels should be keptextremely sharp, so as to ensure controlledbone resection. Blunt instrumentationrequires undue force to be applied, andgouges/chisels may slip off bone andplunge and damage critical structures suchas brain, lateral sinus, facial nerve, innerear, and carotid artery. For the bone workthe surgeon requires the following:Curved periosteal elevatorMalletThree gouges: Large, medium, smallFlat chiselCurettesRongeurs/bone nibblers (small,medium and 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 and AssistantsThe surgeon stands 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, and 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 and mastoid.AntibioticsNo antibiotics are required formastoidectomy for uncomplicatedcholesteatoma, other than when there issecondary infection (mastoiditis).BIPP PasteBIPP Paste can be prepared and used toimpregnate ribbon gauze. This can be usedto pack the mastoid cavity or ear canal, andbecause of its antiseptic properties, may beleft in place for a few weeks.Bismuth subnitrate 20% w/w, iodoform40% w/w, paraffin liquid 40% w/w (w/w =weight for weight)Figure 1: Instruments for bone work2
Surgical anatomy for MastoidectomyFigure 2: Coronal section through middleear and temporal boneBrown: Tympanic segment of base of squamous bone;Green: Antral region; Rose: Subantral region; Red:Region of tip; Blue: Sinus region; Yellow: Cerebellarregion or region of mastoid veinFigure 4: Surface boundaries of mastoidregionsSurgical Steps: Cortical MastoidectomyUnlike with mastoid surgery forcholesteatoma, mastoidectomy for acutemastoiditis may be associated withsignificant blood loss, especially in theabsence of mono- or bipolar coagulation.Patients may even require bloodtransfusion.First Step: Incision of Superficial TissuesFigure 3: Axial view of temporal boneanatomyFigure 5: Incision of Superficial Tissues3
Page 1: OPEN ACCESS ATLAS OF OTOLARYNGOLOGY
Page 5 and 6: appearance of an egg. The spine of
Page 7 and 8: the lateral sinus. This region isme
Page 9 and 10: excavating down towards the antrum
Page 11 and 12: Fifteeeth Step: Drainage and suturi
Page 13 and 14: CERVICAL SEPSISLateral sinus thromb

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?