mastoidectomy

The article was consulted with Specialist Doctor I Tran Minh Tuan - Doctor of Ear, Nose and Throat - Head and Neck Surgery - Department of General Surgery - Vinmec Nha Trang International General Hospital.

In some infectious diseases that have spread to the mastoid tissue and have not been improved by medical treatment, mastectomy is performed early to prevent dangerous complications and have a chance to recover. restore hearing.

The mastoid is the part of the temporal bone that lies behind the ear, filled with air cells made of bone. The mastoid bone contains ventilation cells that are connected to the tympanic cavity with the perineum, from which inflammatory lesions in the middle ear are not treated properly or chronic otitis media with cholesteatoma can cause infection affecting the ear canal. mastoid bone.
mastoidectomy is a type of surgery to remove part or more of the bone behind the ear to create an opening through the mastoid bone, fascia, superior atrium, middle atrium, remove the posterior wall of the ear canal, and connect with the external ear canal. Mastectomy can help prevent damage to the ear, but can cause some hearing loss. Hearing aids can be used after some classic surgeries. However, compared with the risk of more serious complications, it is still indicated.
There are many types of mastoidectomy, including:
Conservative mastectomy: Also known as partial mastectomy, this type of surgery will keep the eardrum and the ossicles. . This method has the advantages of better improved hearing, recurrence rate of otitis media cholesteatoma. Classic mastoidectomy: In this surgery, the entire eardrum, malleus, and anvils are removed, keeping the stirrup bone and blocking the foramen. This type of surgery is often applied to people with complex mastoid disease and today is often combined with middle ear and surgical cavity orthopedics, wide ear opening.

Some indications for mastectomy include:
Otitis with severe bone infection: The mastoid bone is connected to the middle ear through the urethra, so the infection in the middle ear can spread to other organs. ventilation cells in the mastoid bone. Masculectomy is indicated to remove part of the mastoid bone to help stop the spread of infection. Chronic otitis media with cholesteatoma: This is a tumor in the middle ear, causing many dangerous complications such as: brain abscess, deafness, dizziness, damage to nerve VII, meningitis, inflammation of the inner ear, water in the ear... Some contraindications: This surgery has no absolute contraindications. But should be considered in elderly patients, there are many serious medical diseases that are at risk of life-threatening during surgical anesthesia. Severe systemic disease not capable of anesthesia.

3.1 Preoperative preparation Before surgery, the patient should be clearly explained about the surgery, the benefits and the risks of possible complications during and after surgery. The patient needs to do the necessary tests to ensure the surgery is safe, the necessary tests for monitoring and diagnosis such as mastoidography, audiogram.. The patient is shaved off the hair at the back and on the rim of the ear, about 5cm from the rim. Fasting before surgery. 3.2 Procedures The patient can. check the overall status, the previous preparation steps have been done or not. The patient lies with the head turned on the non-operative side. Anesthesia: General anesthesia, then clean the external ear canal and tympanic cavity. Make an incision behind the ear, about 0.5cm from the groove behind the ear, from the temporal line of the apex to the tip of the mastoid. Dissect the fascia to reveal the mastoid surface and the posterior wall of the external ear canal wide enough to visualize the temporal line, Henle spine, and striatum. Then dissect the skin flap behind the outer ear canal and tympanic cavity. Drill into the mastoid bone immediately after the Henle spine, equivalent to the ethmoid area with a large-sized drill, going parallel to the external ear canal, above parallel to the temporal bone, posteriorly to the angle of Citteli and the cortical bone of the trough. lateral vein, inferiorly to the mastoid process to the tip of the biceps muscle. Drill the posterior wall of the bony ear canal. Lower the wall of the Fallopian tube to the level of the hypothalamus, exposing the VII nerve and atrial fissures. Remove the inflammatory tissue, the incus, the remaining parts of the malleus and the tympanic membrane. Remove the inflammatory tissue, keep the tympanic cavity mucosa to the eustachian tube and stapes. Next, use a diamond drill to grind away groups of inflammatory cells, aspirate cholesteatoma and matrix around the semicircular ring, atrial niche, facial recess, proboscis and the entire tympanic cavity. Rinse the surgical cavity with 0.9% saline solution. Orthopedic ear canal and surgical cavity. Close the skin according to the incision steps from the inside out. 3.3 Monitoring and managing complications In surgery: When drilling near the VII nerve, it is necessary to use a diamond drill and use a lot of water to avoid damage to the VII nerve due to the heat effect of the drill. After surgery: In the first 6 days, monitor temperature, general condition, bleeding, facial paralysis, dizziness... From day 8 to 8 monitor temperature, change wound dressing, remove wick, cut sutures. Take medications such as pain relievers and antibiotics as prescribed. Avoid all strenuous activity for the next 2-4 weeks. Do not put pressure on the ears. Complications and management: If the semicircular ring is exposed: Cover with a piece of the temporal muscle fascia. If the facial nerve is exposed due to inflammatory warts: Use a vacuum cleaner and clean water system. Bacterial infections: It is necessary to use antibiotics correctly and enough to avoid infection. Accidents caused by anesthetic drugs such as hypotension, hypothermia, respiratory failure... are treated according to each specific complication.

The mastoidectomy is an early prevention of dangerous complications caused by otitis media or mastoiditis. Patients should perform at reputable otolaryngology facilities to limit the risk of unfortunate complications.
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