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

cauterized or occluded with bone wax. Agauze pack impregnated with theadrenaline and kept in place for severalminutes may reduce bleeding.obliquely on the bony surface. Smallslanting blows made with the gouge permita very careful sculpturing of the cortex ofthe lateral sinus.Lateral Sinus Thrombosis and PerisinusAbscessesAcute mastoiditis may be complicated by aperisinus (extradural) abscess, lateral sinusthrombosis, or there may be pus within thesinus (Figure 18).Figure 16: Exploring the sinodural angleNinth Step: Exploring Lateral SinusThe posterosuperior region of the mastoidis also called the region of the lateral sinus(Figure 17).Figure 18: Thrombosed (L) lateral sinuswith posterior fossa abscessFigure 17: The lateral sinusSince this vessel is sometimes verysuperficial, the gouge is the onlyinstrument that should be used. It is heldbetween the thumb and the first twofingers of the left hand and placedIn the absence of preoperative CT scanningfacilities, the sinus should be uncapped ofbone. If a perisinus abscess is encountered,it is drained into the mastoid cavity. Thesinus is aspirated with a needle andsyringe. Should there be no free flow ofblood, it might be thrombosed, or theremay be an intrasinus abscess that needs tobe drained.Tenth Step: Search for AntrumThe antrum is sought with a small gougedirected from behind forward towards thespine of Henlé, paralleling the canal and8