modified radical mastoidectomy

Modified mastoidectomy is a surgical method that maintains or enhances human hearing without removing or less damage to the internal and inferior tympanic structures under the premise of clearing the mastoid cavity, the entrance of the sinus sinus and the diseased tissue of the upper tympanic cavity. This is an improved procedure based on mastoidectomy. The integrity of the posterior wall of the external auditory canal is not preserved during the operation. It is an "open" operation requiring complete removal of the lesions of the upper tympanic cavity, sinus sinus and mastoid cavity. Keep the ossicular chain intact and do not touch the middle and lower tympanic chambers to maintain or enhance hearing. Due to the increasing use of tympanoplasty, tympanoplasty is performed at the same time as modified mastoidectomy. In addition, according to the condition of the tympanotomy, the upper tympanic cavity - sinus sinus surgery while tympanoplasty, therefore, the surgeon should be proficient in improved mastoidectomy, appropriate according to different lesions during surgery Different procedures. Treatment of diseases: chronic otitis media Indication 1. The cholesteatoma is confined to the upper tympanic cavity, the sinus sinus, the middle and lower tympanic cavity is normal or the inflammation is not heavy, the perforation of the tympanic membrane is perforated or the posterior superior marginal perforation, and the hearing is better or the conductivity is maintained at the application level. 2. Chronic simple or otitis media with otitis media, persistent pus, pus mainly from the upper tympanic cavity or sinus sinus, not suitable for tympanoplasty, poor hearing of the contralateral ear or mastectomy, to maintain this ear Hearer. 3. In the upper tympanic cholesteatoma, the middle and lower tympanic membranes are closed by themselves. Contraindications 1. Cholesteatoma involves a wide range of tympanic membranes. 2. Eustachian tube and tympanic cavity have inflammatory lesions. Preoperative preparation 1. Intravenous antibiotics to control infection. Symptomatic treatment such as infusion according to the general condition of the patient. 2. Shave the hair in the 5cm area around the ear, and the female patient should crunch the hair and comb it to the opposite side. Clean and disinfect the auricle and periorbital skin with 75% ethanol. 3. Clear the secretions of the external auditory canal before surgery, and carry out bacterial culture and drug sensitivity test. 4. Oral pentobarbital 0.1 to 0.2 g or phenobarbital 0.06 to 0.09 g half an hour before surgery. General anesthesia is prepared and used according to general anesthesia. 5. Read X-ray or CT film carefully before operation to understand the degree of mastoid gasification, bone destruction and sigmoid sinus position. 6. Pure tone audiometry should be performed before surgery to understand the hearing situation. Surgical procedure 1. Incision: A conventional incision is made in the ear. 2. Separate the periosteum to separate the periosteum from the incision, expose the papillary cortex and the upper and posterior walls of the external auditory canal, and directly reach the drum incision and the drum ring. 3. There are usually two ways to treat the upper tympanic cavity and the bone bridge: (1) Remove the outer side wall of the upper drum from the drum incision and cut off the bone bridge: it is suitable for the upper tympanic cavity, the drum sinus lesions are wide, the ossicular chain is partially eroded, the middle tympanic part is lesioned, and the hearing is better. The fine-bend probe is gently probed into the upper tympanic cavity from the drum notch, and the depth range is analyzed. The outer wall of the upper drum is opened by the layer-by-layer grinding (chiseling), and the upper tympanic chamber is opened, and the sinus is exposed backward from the entrance of the drum sinus. Treat the same as "Meduloid Radical Surgery". Grind down the posterior wall of the external auditory canal. (2) Remove the outer wall of the upper drum from the entrance of the sinus sinus, and retain the bone bridge: suitable for small perforation of the tympanic membrane, the lesion is limited to the upper tympanic cavity, the ossicular chain is intact or the tympanic membrane is adhered to the middle and lower tympanic cavity, and the hearing is good. Drum sinus and mastoid treatment with mastoidectomy. From the entrance of the drum sinus, it is grounded (chiseled) from the back to the outer wall of the drum to expose the joint of the anvil and to the front wall of the upper tympanic chamber. Thinning and grinding the posterior wall of the external auditory canal to form a bone bridge. The outer segment of the posterior inferior wall of the external auditory canal should also be worn down. 4. The treatment of rupture of the sinus and mastoid lesions of the diseased tissue is the same as "radical mastectomy". The principle of treating the upper tympanic lesion is to preserve the intact ossicular chain or part of the ossicular chain as much as possible to reduce the damage to the ossicular bone to maintain the original hearing. The tissue around the ossicle is separated by a fine needle to observe whether the anvil joint is connected. Generally, the long foot of the anvil often has necrosis. After the anvil joint is separated, the residual anvil is taken out. Cut the hammer bone from the hammer neck. Exposure to the spasm and tympanic membrane muscle tendon. The facial nerve crypt is ground and the facial nerve crypt lesion is removed. Use a small curette, a sharp needle and an ear nipper to remove the cholesteat epithelium and granulation around the upper tympanic cavity and the ossicle. If the tympanic cavity is normal or has been adhered and closed, do not separate and damage the tympanic mucosa. 5. To do the external auditory canal flap, transplant the skin flap, repair the tympanic membrane incision and reverse the external auditory canal flap, and apply it flexibly according to the lesion. Commonly used: 1 from the outer wall of the outer ear canal incision; 2 from the outer ear canal after the upper wall; 3 from the tympanic membrane perforation from the outside to the incision. The posterior or posterior superior wall flap is inverted into the mastoid cavity, and the perforated and absent areas are implanted with the split skin, or the perforation is lined with the temporalis fascia and periosteum to repair the perforation; or the perforation is combined, the missing area Skin grafting. The skin graft is taken from the inner side of the thigh or behind the ear, and is a fault skin. The surface of the skin is covered with Vaseline gauze. The skin is attached to the perforation of the tympanic membrane, the upper tympanic cavity and its superior wall, the sinus sinus, the entrance of the sinus and the skin of the mastoid. . Check the tympanic membrane or graft to connect to the humeral head before the end of the procedure. 6. Fill the iodoform gauze, fix the graft skin and the posterior wall flap of the external auditory canal, and suture the ear incision. The outside of the ear is covered with a sterile dressing, and the bandage is fanned. complication 1. Facial nerve palsy 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. 2. Lost inflammation can be caused by the operation of the external 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. 3. Severe bleeding can be caused by injury to the sigmoid sinus wall or jugular bulb. 4. Cerebrospinal fluid leakage or meningitis caused by damage to the meninges of the cranial fossa. 5. 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. 6. Suppurative auricular perichondritis often caused by surgery to expose cartilage, caused by Pseudomonas aeruginosa infection in the surgery cavity.