Mastoidectomy

Mastoidectomy
Specialty	otolaryngology

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:

Radical

Removal of posterior and superior canal wall, meatoplasty and exteriorisation of middle ear.

Canal wall down

Removal of posterior and superior canal wall, meatoplasty. Tympanic membrane left in place.

Canal wall up

Posterior and superior canal wall are kept intact. A facial recess approach is taken.

Cortical

(Also known as schwartze procedure) - Removal of Mastoid air cells is undertaken without affecting the middle ear. This is typically done for mastoiditis

Modified radical

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)

Further reading

• Mohammed Abdel Tawab H, Mahmoud Gharib F, Algarf TM, ElSharkawy LS (2014). "Myringoplasty with and without Cortical Mastoidectomy in Treatment of Non-cholesteatomatous Chronic Otitis Media: A Comparative Study". Clinical Medicine Insights. Ear, Nose and Throat. 7: 19–23. doi:10.4137/CMENT.S17980. PMC 4133034. PMID 25187749.
• Sun JQ, Sun JW, Hou XY, Bie YZ, Chen JW (March 2015). "Using autogenous mastoid cortical bone cap to cover the mastoidectomy defect during cochlear implantation". International Journal of Pediatric Otorhinolaryngology. 79 (3): 419–22. doi:10.1016/j.ijporl.2015.01.006. PMID 25631936.
• Albu S, Trabalzini F, Amadori M (June 2012). "Usefulness of cortical mastoidectomy in myringoplasty". Otology & Neurotology. 33 (4): 604–9. doi:10.1097/MAO.0b013e31825368f2. PMID 22588236.
• Vadiya S, Kedia A (June 2015). "Atticotomy, Attic Reconstruction, Tympanoplasty with or Without Ossiculoplasty, Canal Plasty and Cortical Mastoidectomy as Part of Intact Canal Wall Technique for Attic Cholesteatoma". Indian Journal of Otolaryngology and Head and Neck Surgery. 67 (2): 128–31. doi:10.1007/s12070-015-0821-z. PMC 4460109. PMID 26075165.
• Cummings CW, Flint PW, Haughey BH, et al. (2005). Otolaryngology: Head & Neck Surgery (4th ed.). St Louis, Mo: Mosby. pp. 3019–20.