12. Mastoidectomy, radical ear surgery (radical mastoidectomy).

Define mastoidectomy

• surgical removal of the infected mastoid air cells → drilled through a retroauricular incision

What are the indications of mastoidectomy

1. mastoiditis that doesn’t respond to antibiotics

2. cholesteatoma

3. implantation of cochlear implant

4. initial step in removal of lateral skull base neoplasms

5. lateral venous sinus thrombosis

6. tumour in inner ear

What are the classifications of mastoidectomy

• simple (cortical, complete)

• modified radical

• radical

What is the difference between modified radical and radical mastoidectomy

• Modified radical- leaves tympanic membrane and ossicles

• Radical- tympanic membrane, malleus and incus are removed → leaves only stapes

What is the result of radical mastoidectomy

• broad connection between mastoid, tympanic cavity, external ear= radical cavity

• almost always combined with tympanoplasty and creation of new typmanic cavity

What are the subclassifications of mastoidectomies

• closed or canal wall up

• open or canal wall down

Describe closed or canal wall up mastoidectomy

• removal of lateral wall of external ear canal

• posterior and superior wall is intact

• simple mastoidectomy

Describe open or canal wall down mastoidectomy

• removal of lateral, posterior, superior walls of external ear canal

• modified radical or radical mastoidectomy

What are the complications of mastoidectomy

1. labyrinthitis/ labirinthitis ossificans

2. chronic infection

3. recurrent/ acquired cholesteatoma

4. perilymphatic fistula

5. trauma to facial nerve

6. trauma to sigmoid sinus and jugular bulb