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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cauterized or occluded with bone wax. Agauze pack impregnated with theadrenaline <strong>and</strong> kept in place <strong>for</strong> severalminutes may reduce bleeding.obliquely on the bony surface. Smallslanting blows made with the <strong>gouge</strong> permita very careful sculpturing of the cortex ofthe lateral sinus.Lateral Sinus Thrombosis <strong>and</strong> PerisinusAbscessesAcute <strong>mastoiditis</strong> 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 <strong>gouge</strong> is the onlyinstrument that should be used. It is heldbetween the thumb <strong>and</strong> the first twofingers of the left h<strong>and</strong> <strong>and</strong> 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 <strong>and</strong>syringe. Should there be no free flow ofblood, it might be thrombosed, or theremay be an intrasinus abscess that needs tobe drained.Tenth Step: Search <strong>for</strong> AntrumThe antrum is sought with a small <strong>gouge</strong>directed from behind <strong>for</strong>ward towards thespine of Henlé, paralleling the canal <strong>and</strong>8