Cortical

mastoidectomy
 Types of Surgeries
1. Myringotomy and Grommet insertion
2. Myringoplasty
3. Tympanoplasty
4. Cortical Mastoidectomy
5. Modified Radical Mastoidectomy
6. Radical Mastoidectomy
 Introduction
• Tympanoplasty is sub-classified based on
– Medial or lateral grafting
– Associated type of ossicular chain reconstruction
(OCR)
 History
• 1640 – Banzer
– First attempt at repair of a TM perforation
– Used pigs bladder as a lateral graft
• 1853 – Toynbee
– Placed a rubber disk attached to a silver wire over the TM
– Reported significant hearing improvement
• 1863 – Yearsley
– placed a cotton ball over a perforation
• 1877 – Blake
– Paper patch
 History
• 1876 – Roosa
– Treated TM perf. with chemical cautery
• 1878 – Berthold
– Coined the term myringoplasty
– Placed cork plaster against TM to remove
epithelium
– Applied a FTSG
 History
• 1950s – Wullstein and Zollner
– STSG over de-epithelialized TM
• 1956 - Wullstein
– Described five types of tympanoplasty
• 1957 – first medial graft performed by Shea with vein
graft
• 1961 – Storrs
– introduced the use of temporalis fascia grafting
– Medial grafting
• 1961 and 1967 – House, Glasscock and Sheehy
– Developed and refined techniques for lateral grafting
Anatomy and Embryology of the
Tympanic Membrane
Embryology
 Embryology
• 4th week of gestation
• TM develops from three sources
– Ectoderm – 1st branchial groove
– Endoderm – 1st branchial pouch
– Mesoderm – 1st and 2nd branchial arches
Embryology
 Anatomy
• TM is oval in shape
– 8 mm X 10 mm
– 55 degrees to the floor of the meatus
– Near circumferential fibro-cartilaginous thickening
• Annular ligament or annulus
– 3 layers – 130 microns thick
• Outer epithelial – keratinizing squamous
• Middle fibrous – superficial radial, deep circular
• Inner – mucosa
– Epithelial migratory pattern
• Centrifugal growth for the umbo outward
Anatomy
Anatomy
 Anatomy
• Blood supply
– Inner surface
• Ant. Tymp a.
– Outer surface
• Deep auricular
a.
Blood Supply
Anatomy
 Cortical Mastoidectomy
• Exenteration of all the mastoid air cells is done with
• Superiorly : up to tegmen plate,
• posteriorly up to sinus plate,
• inferiorly upto mastoid tip
• anteriorly upto EAC
• medially upto lateral semi circular canal cover
• Opening of the antrum is enlarged
• From the antrum various cells tract are followed
• A drain is kept in the mastoid cavity and wound is closed in
• With antibiotic coverage, the wound may be sutured without any
drainage.
• A mastoid dressing is applied.
 Cortical Mastoidectomy
The landmarks seen after cortical mastoidectomy
include:
• Dural (Middle Cranial fossa) plate.
• Sigmoid sinus plate.
• Sinodural angle plate.
• Thinned bony posterior canal wall.
• Bony lateral semicircular canal at the floor of
antrum.
• Mastoid tip air cells.
• External genu of facial nerve.
• Fossa incudis.
Cortical Mastoidectomy
 Cortical Mastoidectomy
Post Operative care:
Antibiotics, anti-inflammatory, analgesic,
decongestant are given
Keep the operated ear up.
Drain can be removed after 48 hrs
Mastoid dressing can be removed on 7th or 10th
day along with sutures.
 Cortical Mastoidectomy
• Facial nerve injury:
Heat generated by diamond burr can cause nerve
injury.
Facial nerve can be traumatized during surgery.
By instrumentation during surgery
• Sigmoid sinus injury: Injury to the sigmoid sinus, the superior
petrosal sinus, jugular bulb, mastoid emissary vein result in profuse
bleeding which can be controlled by occlusion by packing with gel
foam
• Injury to the tegman plate with CSF leak- gel foam packing
• Dislocation or removal of the incus: Dislocation or removal of the
incus results in severe conductive hearing loss. This can be
managed by tympanoplasty operation.
• Injury to Labyrinth may cause giddiness
• Persistence of discharge from the ear
• Meatal stenosis