Cortical Mastoidectomy
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🦻 Cortical Mastoidectomy
📌 Definition of Cortical Mastoidectomy
Cortical mastoidectomy removes accessible mastoid air cells and converts them into one cavity, maintaining the posterior canal wall and preserving tympanic membrane/ossicles.
What are the other names of Cortical Mastoidectomy?
What are the aims of Cortical Mastoidectomy?
🩺 Indications of Cortical Mastoidectomy
- Acute coalescent mastoiditis ± subperiosteal abscess
- Masked mastoiditis
- Acute otitis media with reservoir sign not resolving on antibiotics
- CSOM (mucosal type) with sclerotic mastoid and persistent infection
- Limited cholesteatoma confined to antrum/aditus
- As an access step for other procedures
- Part of combined-approach tympanoplasty
What are the different surgeries of which Cortical Mastoidectomy is a part of?
⛔ Contraindications of Cortical Mastoidectomy
- Medically unfit for surgery.
- Extensive/recurrent cholesteatoma requiring canal-wall-down surgery.
- Posterior canal wall defect not reconstructable.
Is active ear discharge a contraindication of Cortical Mastoidectomy?
🛠️ Preop preparation & anaesthesia
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General anesthesia preferred.
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Position: supine, face turned away, ear to be operated facing upward.
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Local infiltration: 1% lignocaine + adrenaline to tragus, postauricular skin, selected EAC quadrants.
🔪 Steps of Cortical Mastoidectomy
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Incision: Wilde's curved post-auricular incision ~1 cm behind & parallel to retroauricular sulcus
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Periosteal exposure: T-shaped periosteal incision (horizontal along linea temporalis + vertical down to mastoid tip). Elevate periosteum to expose mastoid cortex.
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Identify McEwan’s triangle → drill ~12–15 mm deep to reach mastoid antrum.
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Drill mastoid cortex & remove air cells:
- Remove Korner septum to access true antrum.
- Exenterate all accessible mastoid, zygomatic & retrosinus cells.
- Drill mastoid tip → expose digastric ridge.
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Identify deep landmarks: lateral semicircular canal, incus, tegmen plate, sinus plate, sinodural angle, Trautmann’s triangle, endolymphatic sac (via Donaldson’s line).
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Saucerize cavity
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Closure: Layered closure + mastoid dressing.
What are the limits of cortical mastoidectomy?
What is Korner's septum? What is it's clinical significance?
What are the boundaries of McEwan's triangle?
🩹 Post-operative care of Cortical Mastoidectomy
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Mastoid dressing off after 24–48 hrs.
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Water precautions for ~6 weeks.
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Continue antibiotics for 7 days; analgesics.
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Remove sutures at ~7 days.
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First otoscopic exam at 3 weeks.
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Pure-tone audiometry at 6–8 weeks.
⚠️ Complications of Cortical Mastoidectomy
- Bleeding, wound infection.
- Facial nerve injury.
- Dural tear / CSF leak.
- Sigmoid sinus injury/thrombosis.
- Residual disease if Korner septum missed.
- Post-op hearing changes.
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