--- title: "Complications of Mastoidectomy" description: "ENT notes on Complications of Mastoidectomy - Intraoperative and Postoperative." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/complications-mastoidectomy" categories: ["Otology", "Surgery"] video: "https://www.youtube.com/watch?v=VsPNn5HnP9g" image: "https://media.theentresident.com/og-images/complications-mastoidectomy.png" --- # Complications of Mastoidectomy ENT notes on Complications of Mastoidectomy - Intraoperative and Postoperative. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=VsPNn5HnP9g ## đŸĻģ Complications of Mastoidectomy Complications of mastoidectomy are grouped as: - **Intra-operative complications** — problems that occur during surgery. - **Post-operative complications** — subdivided into **early** and **late**. --- ### 🛠 Intra-operative complications of Mastoidectomy **1- Bleeding** - **Causes:** injury to emissary veins, sigmoid sinus, dural venous channels, middle meningeal artery, posterior auricular/occipital branches, or from granulations/cholesteatoma bed. - **Prevention:** meticulous anatomy knowledge, careful drilling, good hemostasis. >How to manage intra operative bleeding during Mastoidectomy? >Why is Sigmoid sinus injury dangerous? **2- Facial nerve injury** - **Common sites:** tympanic segment, second genu, vertical segment. - **Management:** - Transection → repair/graft. - Partial → decompression + steroids, eye care, physiotherapy. >What is the most common site of facial nerve injury in Mastoidetomy? >What are the risk factors which increase the risk of facial nerve injury? >What measures can you take to prevent facial nerve injury? **3- Chorda tympani injury** - **Presentation:** altered taste (metallic/bitter), reduced salivation. - **Prognosis:** usually transient (neural adaptation). - **Management:** reassurance, symptomatic care. **4- Labyrinthine injury (Lateral SCC fistula)** - **Cause:** cholesteatoma erosion, surgical trauma. - **Presentation:** perilymph leak, vertigo, SNHL. - **Management:** - If matrix intact → preserve. - If exposed → seal with bone dust + fascia/fat. **5- Dural plate/tegmen injury & CSF leak** - **Risks:** CSF leak, meningitis, brain herniation. - **Management:** - Small exposure → cover with fascia. - Leak → watertight fascia/cartilage closure, acetazolamide, bed rest, lumbar drain if needed. **6- Sigmoid sinus injury** - **Presentation:** massive hemorrhage, risk of air embolism. - **Management:** pressure, bone wax, Surgicel, muscle packing, IV fluids. **7- Ossicular chain injury** - **Effect:** conductive hearing loss. - **Management:** ossiculoplasty. >What is the most common ossicle to be injured? **8- Stapedial muscle injury** - **Effect:** hyperacusis (loss of stapedius reflex). - **Prognosis:** often asymptomatic, compensated by tensor tympani. - **Management:** reassurance, rarely sound therapy/hearing aids. --- ### ⏱ Early Post-operative Complications of Mastoidectomy **1- Hematoma** - **Site:** post-auricular incision region. - **Management:** evacuate clot, cauterize bleeder, compressive dressing. **2- Wound infection / abscess** - **Features:** swelling, discharge, fever. - **Management:** IV antibiotics, drainage if abscess, wound care. **3- Vertigo** - **Cause:** labyrinthine irritation (suction, drill heat, labyrinthitis). - **Management:** bed rest, vestibular sedatives. **4- Sensorineural hearing loss / Dead ear** - **Cause:** drill/suction trauma, labyrinth damage. - **Management:** steroids, hyperbaric oxygen if available. - **Dead ear:** rare, severe SNHL — poor prognosis. **5- Persistent CSF leak** - **Cause:** missed/poorly repaired tegmen breach. - **Presentation:** watery otorrhea, meningitis risk. - **Management:** surgical repair, lumbar drain, antibiotics. **6- Delayed facial nerve palsy** - **Cause:** thermal trauma, edema, tight packing, viral reactivation. - **Management:** remove tight pack, steroids, eye care, physiotherapy. --- ### 🕰 Late Post-operative Complications of Mastoidectomy **1- Residual/recurrent cholesteatoma** - **Cause:** incomplete clearance or retraction pocket. - **Management:** revision mastoidectomy. **2- Persistently discharging cavity** - **Causes:** high facial ridge, poor meatoplasty, residual sac. - **Management:** revision mastoidectomy, cavity obliteration, aural toileting. **3- Meatal stenosis** - **Cause:** poor meatoplasty, canal skin loss. - **Management:** revision meatoplasty, skin grafting. **4- Tympanic membrane issues** - **Problems:** graft failure, reperforation, atelectasis. - **Management:** revision tympanoplasty. **5- Ossiculoplasty failure** - **Causes:** extrusion, resorption, ET dysfunction. - **Presentation:** persistent CHL. - **Management:** revision ossiculoplasty. **6- Caloric vertigo** - **Cause:** cold air/water stimulates labyrinth in open cavity. - **Management:** cavity obliteration, water precautions. **7- Cosmetic deformity** - **Cause:** excessive bone removal, post-auricular depression. - **Management:** obliteration with fat/cartilage, local flaps. --- ## About This Note This free ENT note on Complications of Mastoidectomy was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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