Canal wall down tympanomastoidectomy
by Vicky S Khattar, Vicky Bachi T

Jaypee’s Video Atlas of Operative Otorhinolaryngology AND Head & Neck Surgery

by Vicky S Khattar, Bachi T Hathiram
About Video

This video demonstrates the technique preferred by the authors for the surgical management of cholesteatoma. Their preference for a wide exposure, the use of a large burr to drill over the mastoid cortex, the use of copious saline irrigations, the use of a large graft of temporalis fascia, performing a wide meatoplasty, etc. have been outlined. These have proved to be invaluable to achieve a successful outcome in the authors’ experience. In their experience, it is best to start drilling using a large cutting burr over the ridge, gently widening the bony external auditory canal along its posterior wall and simultaneously entering the mastoid antrum. This helps to prevent inadvertent damage to bone overlying important structures such as the dura or sinus. Copious irrigation ensures good visibility and prevents thermal injury to the neural tissue. It is best to use a temporalis fascia graft, large enough to cover as much of the middle ear and bare bone of the mastoid cavity as this helps in healing. Finally, an adequately sized meatoplasty helps to achieve a healthy, well-areated postoperative cavity.

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