The technique of atrial septal cell surgery

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.

Ear surgery is always a challenge for ENT surgeons, these surgeries require very high expertise, technique and support facilities. And the technique of atrial cystectomy is one of those surgeries.

The term Atrial spondylolisthesis - atrial patching was used in the 1960s, now called this technique type II middle ear orthopedic.
Atrial cystoplasty is an emergency surgery in infants and needs to be done quickly. Today, this technique is not only limited to opening the fascia, but to completely solve it, the doctor can expand it to the mastectomy technique, combined with the tympanic membrane catheter in the case of mastoiditis. grant .
Atrial cystectomy is surgery to expose the mastoid bone, internal structures and the middle region of the temporal bone, leaving intact the posterior wall of the ear canal and bone, helping to correct the osseous system and the tympanic membrane to conduct drainage. Transmits sound wave pressure directly into the inner ear fluid.
This method helps to solve the inflammation of the mastoid and middle ear mucosa, helps to restore the anatomy to solve the dry ear, thereby partially restoring hearing function.

Atrial cystectomy is indicated in the following cases:
Disturbance of the ossicle system in the ear due to inflammation causing damage to the malleus, or the lack of long branches of the anvil, or necrosis of the stapes. Fix the head of the malleus, anvil, or the entire chain of subbones. Hearing loss due to inflammation of the middle ear and mastoid bone. Chronic otitis media and mastoiditis can be mild or receptive. Complications of acute otitis media include acute mastoiditis and extraperiosteal abscess. Epiglottitis is contraindicated in the following cases:
Osteoarthritis. Cholesteatoma is widespread and uncontrolled. Poor function of the eustachian tube due to an infection in the nasopharyngeal region. Atrial septal opening - atrial patch should not be performed in children under 7 years of age to avoid recurrent otitis media.

The person performing the surgery must be a specialist level I Ear, Nose Throat or higher, with experience in ear surgery. Equipment to be prepared includes: Surgical microscope, ear drill, ear microsurgery instruments, irrigation system. Patients: Need to be clearly explained the possible complications before, during and after surgery. The patient needs to have ear medicine and cut the hair behind the earlobe 2cm from the hairline. Medical record: It is necessary to complete a description of the general condition and other diseases of the ear, nose, and throat area. The patient needs to have the necessary test results such as: CBC, blood test - coagulation, blood sugar, blood urea, urinary tract, proteinuria, chest X-ray film, Schuller film and audiogram , CT scan in case of suspected bone lesions, cholesteatoma.

Before surgery, the patient needs to be under general anesthesia. Then the doctor opens the epiglottis through the following steps:
It is possible to operate the line before the ear or behind the ear. The line behind the ear: The doctor will make an incision behind the ear 0.5cm from the posterior ear groove, starting from the level of the temporal line and continuing to the mastoid process. Expose the temporomandibular fascia, then take a piece of the temporal fascia to patch the tympanic membrane in the next step. Exposing the mastoid surface, revealing the anatomical landmarks: Zygoma roots, Henle spines, temporal line, ethmoid region, mastoid process. Exposing the posterior wall of the external ear canal: The doctor will cut the vasomotor area of ​​the skin of the outer ear canal in the direction from 6 to 12 o'clock, at the level of the mastoid bone, through this incision the doctor can observe the tympanic cavity and the membrane perforation. atrium in front. The doctor then dissected the skin of the ear canal to the tympanic groove, and then removed the epidermis of the perforated eardrum. Use a drill to expand the ear canal wall to see the tympanic cavity clearly. The doctor uses a bone drill to open the planar pole from the side of the mastoid through the ethmoid area. Upper opening up to the temporal line is the mastoid ceiling. The middle passes through the Korner septum into the pole. Posteriorly is the lateral vein bone trough. Located between the margin of the lateral vein and the base of the cell, is the posterior semicircular ring. In front of the open pole and the pole, in the middle, you will see a white edge that is the outer semicircular rim. Anteriorly, the Zygoma root will be exposed and downward to expose the entire posterior wall of the ear canal, thinning this wall until the transverse incus and hammer-anvil joint can be clearly seen.
The doctor opens the triangle of bones and looks into the tympanic cavity. This triangle has a lateral side of the mastoid segment of the facial nerve, a lateral edge of a branch of the tympanic nerve, and the base of the triangle a bony pillar that limits the transverse anvil branch in the middle. The doctor conducts an examination of the musculoskeletal system. If the baby bone is stiff, fix the stirrup joint, it is necessary to remove the sticky bone to move. If the incus, stapes, or malleolus are fractured, the doctor will have to remove them. Remains of the incus or malleus can be used to reconstruct the conduction system. The doctor can also use prefabricated bioceramic or plastic materials to replace the baby bones. The doctor will use a piece of the temporal muscle fascia or use a gelaspon to fix the position of the newly created sound transmission system.
The doctor places the temporal muscle fascia piece through the external ear canal. This piece of muscle fascia is placed under the surface of the eardrum or on the outside surface of the perforated eardrum, then the eardrum is patched. The doctor will then place pieces of gelaspon to fix the temporomandibular fascia.

In order to limit the occurrence of accidents, during surgery, doctors should pay attention to:
Pay attention to the abnormal positions of the facial nerves, the fascia and the lateral veins. Be careful when using sharp instruments to avoid injury to the facial nerve, posterior semicircular ring, and lateral semicircular ring. If bleeding in the lateral vein: The doctor needs to temporarily stop the surgery to stop the bleeding locally. After surgery, you need to monitor to detect and promptly handle the following complications:
It is necessary to remove all the wicks in the ear canal after 8 days of surgery. You need to watch for symptoms of bacterial infection and signs of meningitis. Facial paralysis due to touch, due to compression edema: Need treatment with corticosteroids and antibiotics. Vinmec International General Hospital is a high-quality medical facility in Vietnam with a team of highly qualified medical professionals, well-trained, domestic and foreign, and experienced.
A system of modern and advanced medical equipment, possessing many of the best machines in the world, helping to detect many difficult and dangerous diseases in a short time, supporting the diagnosis and treatment of doctors the most effective. The hospital space is designed according to 5-star hotel standards, giving patients comfort, friendliness and peace of mind.