Radical mastoidectomy and tympanoplasty

Mastoidectomy and tympanoplasty are also known as open mastoidectomy with tympanoplasty. This procedure is suitable for patients with cholesteatoma otitis media and chronic otitis media with extensive lesions, and who are unsafe with combined tympanoplasty. The main advantages are: 1 easy to completely remove the lesion; 2 postoperative cholesteatoma recurrence is easy to find early; 3 through the ossicular chain reconstruction and tympanic membrane repair, to improve hearing within possible range; 4 dry ear rate than simple mastoid radical surgery high. Treatment of diseases: otitis media, middle ear pressure injury Indication 1. A wide range of cholesteatoma otitis media and chronic otitis media. 2. Eustachian tube function is good. 3. The two windows function normally. Contraindications 1. Irreversible obstruction of the eustachian tube. 2. There is acute upper respiratory tract inflammation. 3. There are serious systemic diseases such as hypertension, heart disease, diabetes and coagulopathy. 4. Severe sensorineural hearing loss. Preoperative preparation 1. According to the preoperative examination results, introduce the patient to the purpose of the operation and its brief surgical procedure. At the same time, the possible situation during the operation and the prognosis of the operation can be proposed so that the patient's understanding and cooperation can be obtained. 2. Shave the ear and ear hair before surgery; for the posterior auricular approach or the removal of the temporalis fascia as a transplanter, the range of the ear skin preparation should be widened accordingly. 3. 1d before surgery, the ear canal was removed from the cartilage segment of the external auditory canal, and the internal auditory canal and suede were removed. Then wipe the skin of the external auditory canal and the outer side of the auricle with a 3% boric acid ethanol or 70% ethanol cotton swab. However, the disinfectant is prevented from flowing into the tympanic cavity to avoid earache, reactive hyperemia of the tympanic mucosa, and increased secretion. 4. Systemic antibiotics were applied 1 day before surgery. Adults received oral phenobarbital 0.09g 1 hour before surgery. 5. Perform bacterial culture and drug sensitivity test on the secretion of external auditory canal. 6. X-ray of the mastoid, to determine the extent of the mastoid lesions and mastoid gasification. Surgical procedure 1. The incision can be performed in the ear or behind the ear (see "Mastectectomy" and "Chronic otitis media simple mastoidectomy"). 2. Open the sinus, mastoid and upper tympanic cavity, complete a mastoid root canal that communicates with the external auditory canal, the specific steps are the same as "radome radical surgery". If you want to improve your hearing and do tympanoplasty, the medial section of the facial nerve palsy should not be excessively worn and keep the normal structure of the middle ear as much as possible. 3. Reconstruction of the ossicular chain and tympanic membrane repair after mastoidectomy destroyed the upper and posterior superior wall of the external auditory canal supporting the tympanic membrane. At this time, the transplant tympanic membrane can be attached to the horizontal section of the facial nerve and connected to the humeral head to form a tympanoplasty similar to the Wülltein III type. However, the shortcoming of this method is that the middle ear cavity is narrow, the transplanted tympanic membrane is easy to adhere to the inner wall of the drum, and the area ratio between the tympanic membrane and the tibia floor is reduced, so it is rarely used. In order to overcome this disadvantage, cartilage or mastoid cortical bone can be used to support the tympanic membrane near the upper inner wall of the upper edge of the facial nerve canal. The method of ossicular chain reconstruction depends on the condition of the tibia. If the upper part of the humerus is defective, the bone or cartilage column is placed on the foot plate, and the outer side is connected with the transplanted tympanic membrane; if the humerus is present, the transplanted bone is buckled to the humeral head and the outer end is connected with the tympanic membrane. See "Reconstructing the tympanoplasty of the ossicular chain." 4. The iodoform gauze is filled in the external auditory canal and the mastoid cavity. complication 1. The recurrence of cholesteatoma in the middle and lower drums is related to the incomplete removal of the lesions during the operation. 2. Facial paralysis can occur during surgery and after surgery. In the operation, the position of the sinus sinus is too low, the operation of the broken bone bridge is inadvertent, the electric drill or the osteotome slips off, the injury caused by the exposed facial nerve is attracted, and the facial nerve and the flexion are damaged. Explore decompression or nerve grafting. The facial paralysis that occurs after the operation is mostly due to inflammation or gauze packing, and the facial nerve edema is caused by compression. After non-surgical treatment, the gauze extraction can fully recover. 3. Lost inflammation can be caused by the operation of the outer semicircular canal, dislocation of the humerus, removal of the covering on the lost fistula, etc., causing serous or purulent labyrinthitis, such as "dead lost" can lead to total paralysis. 4. Severe bleeding can be caused by injury to the sigmoid sinus wall or jugular bulb. 5. Cerebrospinal fluid leakage or meningitis caused by damage to the meninges of the cranial fossa. 6. Long-term pus after surgery is not only the mastoid, tympanic lesions are not completely eradicated, facial nerve spasm is too high, bone bridge is not removed, affecting drainage, observation and dressing change. 7. Suppurative auricular perichondritis often caused by surgery to expose cartilage, caused by Pseudomonas aeruginosa infection in the surgery cavity.