Canal Wall Up Mastoidectomy,

Prepared by Dr. Fadhil Mohamed

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Introduced by Jansen at the House Ear Clinic in 195. !he aim is to e"enterate the mastoid air cell system as completely as possible. !o per#orm more conser$ati$e sur%ery & preser$e the normal anatomy o# the e"ternal auditory canal. 'ea$es the patient (ith more options #or hearin% aids postoperati$ely postoperati$ely. p ostoperati$ely..

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Disad$anta%e ) the hi%her postoperati$e rate o# cholesteatoma as compared to canal (all do(n procedures. procedures. Postoperati$e cholesteatoma)either recurrent or residual disease. *esidual disease ) presence o# cholesteatoma due to incomplete e"cision at the time o# initial sur%ery+ *ecurrent disease ) ne( #ormation o# a cholesteatoma #rom a ne( retraction poc,et postoperati$ely.

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Chances o# #ailure can be decreased (ith certain pre$entati$e measures+ includin% usin% -ilastic sheetin%+ repairin% bony de#ects o# the posterior canal (all+ per#ormin% a sta%ed second loo, sur%ery+ and placin% pressure euali/ation tubes.

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Planned second loo, sur%ery at 0 to 1 months postoperati$ely to e$aluate #or residual or recurrent disease+ (ith or (ithout reconstruction o# the ossicular chain. !he status o# the ossicular chain is more predicti$e o# postoperati$e hearin% than the type o# mastoidectomy per#ormed.

 Indications: 

Complications o# acute otitis media+ chronic otitis media+ cholesteatoma+ e"posure o# structures (ithin or deep to the temporal bone+ cerebrospinal #luid otorrhea+ #acial ner$e trauma+ and neoplasm o# the temporal bone.

Preoperative preparation : 2eneral e"amination to assess #itness #or 2.3. C4- e"amination i# intracranial complications are suspected. Facial ner$e mo$ement e"amination to e"clude preoperati$e Facial ner$e paralysis. 

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Full blood count. Ear s(ab) in cases o# otorrhoea+ intracranial complications. *outine audiometry) measures postoperati$e pro%ress. Hi%hresolution C.!. o# the temporal  Hi%hresolution bones ) intraoperati$e plannin% + #eatures o# sur%ical si%ni#icance+ such as a dehiscent #acial ner$e or te%men tympani.

POSITIONING AND PREPARATION: 

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!he patient6s hair should be sha$ed appro"imately 7 cm behind and abo$e the ear to be operated upon. !he positionin% o# the patient is ,ey in all otolo%ic sur%ery. For the C8 mastoidectomy+ the patient should be positioned on the operatin% table such that the head is located at the #oot o# the bed.

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!he bed controls should be easily (ithin reach o# the anesthetist.

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!he patient should be securely strapped to the table .

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!he patient6s head should be located at the $ery end o# the bed+ closest to the sur%eon6s side+ and the head should be rotated a(ay #rom the sur%eon and held in position by a rin%.

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!he #acial ner$e monitor+ i# it is to be used+ should be placed #ollo(in% the induction o# anesthesia. Electrodes are chec,ed #or proper #unction prior to the case.

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!he sur%ical #ield should be prepped (idely (ith the sur%eon6s choice o# sterile solution+ includin% inside the e"ternal auditory canal. :arious methods are used to secure the patient6s hair a(ay #rom the #ield+ includin% paintin% the hair (ith ;etadine+ or tapin% it securely a(ay (ith plastic tape and ben/oin.

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!he patient is then draped in the routine #ashion and placed in a sli%ht !rendelenbur% position& the head is draped (ith an ear hole. !he operatin% room should be set up (ith the anesthetist at the patient6s #eet.

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!he bed is rotated oneuarter turn #ollo(in% induction o# anesthesia. !he sur%eon should be seated at a com#ortable hei%ht at the patient6s head. !he scrub nurse and instrument table should be located either ad> or 5> mm lens is used #or otolo%ic sur%ery.

 INSTRUMENTATION: *outine otolo%ic instrumentation+ :arious si/es o# cuttin% and diamond burs are needed to complete the mastoidectomy. 3 suction irri%ation system is also crucial #or mastoid sur%ery. 

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!he suction system should be set up (ith multiple canisters in series+ to a$oid ha$in% to chan%e canisters #reuently durin% the procedure. nipolar and bipolar cautery as (ell as otolo%ic instrumentation #or the middle ear should be a$ailable.

OPERATIVE TECHNIQUE: ?nce the patient is prepped and draped+ local in>+>>> dilution epinephrine #or $asoconstriction. 3 postauricular in