Tympanoplasty for modified radical mastoidectomy

The tympanoplasty of modified mastoidectomy is an operation that does not open the mastoid cavity, but removes the lesions in the upper tympanic cavity and the sinus sinus through the external auditory canal, and reconstructs the sound structure. Cholesteatoma otitis media occurs mostly in patients with sclerosing mastoids, and only 15% of those with gasified mastoids. Therefore, for most cholesteatoma otitis media, tympanoplasty with modified mastoidectomy can achieve the purpose of clearing the lesion and reconstructing the hearing under the condition of leaving a small operation cavity. This is the main advantage of the surgery. Treatment of diseases: otitis media Indication 1. The cholesteatoma lesion is limited to the upper tympanic cavity, the sinus sinus entrance or the sinus sinus, the mastoid cavity is normal or the mastoid air chamber is not developed. 2. The tympanic membrane is intact or perforated, and the ossicular chain is normal or defective. 3. The eustachian tube function is normal, and the bone conduction threshold is within 30 dB. 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. Incision: Generally take the incision in the ear. 2. Exposing the surface of the mastoid marker to separate the soft tissue before and after the incision, and then separating the skin of the posterior wall of the external auditory canal into the drum ring. The skin on the upper wall is separated to the gingival arch, and all the surface signs of the mastoid are exposed. 3. Open the upper tympanic cavity to remove the upper part of the external auditory canal and remove the periosteal flap of the external auditory canal to the outer side wall of the upper drum. Then expose and open the outer side wall of the upper drum to expose the hammer bone and the anvil bone. If the upper tympanic lesion invades the entrance of the sinus and the sinus cavity, it can be opened upwards in turn. If the lesion is limited to the upper tympanic cavity and wraps around the malleus and the anvil, the hammer neck should be cut, the head and the anvil should be removed, and the lesion should be carefully removed. 4. Repair the defect of the outer wall of the upper drum to take the cartilage piece or bone piece, which is embedded in the defect of the outer wall of the upper drum. A gelatin sponge is placed in advance in the upper drum to support the graft. Preferably, the bone graft is fixed to the adjacent bone wall with fibrin glue. 5. Reconstruct the ossicular chain and repair the tympanic membrane ossicular chain reconstruction according to the type of ossicular chain lesions. If the tympanic membrane is perforated, the graft fascia closes the perforation and covers the outer side wall of the reconstruction tympanic cavity; if the tympanic membrane is missing, the lower edge of the graft fascia is lined on the inner side of the upper edge of the residual tympanic membrane. 6. Reset the flap and fill the external auditory canal. complication 1. Face to face. 2. Cholesteatoma recurrence. 3. Transplantation of the tympanic membrane above the invagination, adhesion.