Mastoidectomy

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.

Further reading

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