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

excavating down towards the antrum withsmall taps of the mallet (Figure 19).Figure 20: Probing the aditusFigure 19: Accessing the antrumWith the superficial antral region open,this step is particularly easy and the antrumis accessible even when small and deeplylocated. The antrum is enlarged above andposteriorly, either with a gouge or curette.Small curettes which may result indangerous slips should not be used. Theaditus is located with a blunt angularprobe. This permits a determination of thestatus of the tegmen tympani superiorly,especially at the level of the antral roof.Twelfth Step: Opening the Deep AntralRegion (Figure 21)The antrum is enlarged toward its posteriorpart. Between the posterosuperior regionjust opened and the antrum there is a bonyridge which should be resected. Thisresection is performed with a gouge ofmedium calibre held obliquely frombehind forward between the thumb andfirst two fingers of the left hand; theremaining two fingers rest on the bonysurface. Thus a horizontal trench is madewhich is almost perpendicular to theanterior vertical one.Eleventh Step: Opening the Deep AntralRegionAfter widely opening the antrum, theaditus is sought with a blunt curved probe(Figure 20). It is carefully cleansed with amedium sized curette. Very small curettesshould not be used since they may slip andcause serious injuries.Figure 21: Approaching deep antralregion9