Mastoidectomy

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Mastoidectomy
Specialtyotolaryngology

A mastoidectomy is a procedure performed to remove the mastoid air cells. This can be done as part of treatment for mastoiditis, chronic suppurative otitis media or cholesteatoma. In addition, it is sometimes performed as part of other procedures (cochlear implant) or for access to the middle ear. There are classically 5 different types of mastoidectomy:

  1. Radical Mastoidectomy - Removal of posterior and superior canal wall, meatoplasty and exteriorisation of middle ear.
  2. Canal Wall Down Mastoidectomy - Removal of posterior and superior canal wall, meatoplasty. Tympanic membrane left in place.
  3. Canal Wall Up Mastoidectomy - Posterior and superior canal wall are kept intact. A facial recess approach is taken.
  4. Cortical Mastoidectomy (Also known as schwartze procedure) - Removal of Mastoid air cells is undertaken without affecting the middle ear. This is typically done for mastoiditis
  5. Modified Radical Mastoidectomy - This is confusing because it is typically described as a radical mastoidectomy while maintaining the posterior and superior canal wall which reminds the reader of the Canal Wall Up Mastoidectomy. However, the difference is historical. Modified radical mastoidectomy typically refers to Bondy's procedure which involves treating disease affecting only the epitympanum. Diseased areas as well as portions of the adjacent superior and posterior canal are simply exteriorised without affecting the uninvolved middle ear.The structures are preserved to reconstruct hearing mechanism at the time of surgery or in second-stage operation.

In Radical and Modified Mastoidectomy the mastoid and middle ear cavities are exteriorized so as not to give the chance for the infection or the cholesteatoma for that matter to spread into the middle cranial fossa.Since the cavities are exteriorized further inspection and cleaning could be done regularly.(Source:HT, flash007)

References[edit]

1. Myringoplasty with and without Cortical Mastoidectomy in Treatment of Non-cholesteatomatous Chronic Otitis Media: A Comparative Study. Mohammed Abdel Tawab H, Mahmoud Gharib F, Algarf TM, ElSharkawy LS. Clin Med Insights Ear Nose Throat. 2014 Aug 12;7:19-23. doi: 10.4137/CMENT.S17980. eCollection 2014. PMID 25187749 2. Using autogenous mastoid cortical bone cap to cover the mastoidectomy defect during cochlear implantation. Sun JQ, Sun JW, Hou XY, Bie YZ, Chen JW. Int J Pediatr Otorhinolaryngol. 2015 Mar;79(3):419-22. doi: 10.1016/j.ijporl.2015.01.006. Epub 2015 Jan 16. PMID 25631936 3. Usefulness of cortical mastoidectomy in myringoplasty. Albu S, Trabalzini F, Amadori M. Otol Neurotol. 2012 Jun;33(4):604-9. doi: 10.1097/MAO.0b013e31825368f2. PMID 22588236 4. Atticotomy, Attic Reconstruction, Tympanoplasty with or Without Ossiculoplasty, Canal Plasty and Cortical Mastoidectomy as Part of Intact Canal Wall Technique for Attic Cholesteatoma. Vadiya S, Kedia A. Indian J Otolaryngol Head Neck Surg. 2015 Jun;67(2):128-31. doi: 10.1007/s12070-015-0821-z. Epub 2015 Jan 9. PMID 26075165

Further reading[edit]

  • Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005:3019–3020.