--- title: "Cortical Mastoidectomy" description: "Comprehensive ENT notes on Cortical Mastoidectomy - Definition, Aims, Indications, Contraindications, Procedure and Post operative care - ideal for MBBS and ENT students." source: "The ENT Resident" canonical_url: "https://www.theentresident.com/ent-notes-lectures/cortical-mastoidectomy" categories: ["Otology", "Surgery"] video: "https://www.youtube.com/watch?v=r4-le1xg4UQ" image: "https://media.theentresident.com/og-images/cortical-mastoidectomy.png" --- # Cortical Mastoidectomy Comprehensive ENT notes on Cortical Mastoidectomy - Definition, Aims, Indications, Contraindications, Procedure and Post operative care - ideal for MBBS and ENT students. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=r4-le1xg4UQ ## 🦻 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 - General anesthesia preferred. - Position: **supine**, face turned away, ear to be operated facing upward. - Local infiltration: 1% lignocaine + adrenaline to tragus, postauricular skin, selected EAC quadrants. --- ### 🔪 Steps of Cortical Mastoidectomy 1. **Incision:** Wilde's curved post-auricular incision ~1 cm behind & parallel to retroauricular sulcus 2. **Periosteal exposure:** T-shaped periosteal incision (horizontal along linea temporalis + vertical down to mastoid tip). Elevate periosteum to expose mastoid cortex. 3. **Identify McEwan’s triangle** → drill ~12–15 mm deep to reach mastoid antrum. 4. **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. 5. **Identify deep landmarks:** lateral semicircular canal, incus, tegmen plate, sinus plate, sinodural angle, Trautmann’s triangle, endolymphatic sac (via Donaldson’s line). 6. **Saucerize cavity** 8. **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 - Mastoid dressing off after **24–48 hrs**. - **Water precautions** for ~6 weeks. - Continue antibiotics for 7 days; analgesics. - Remove sutures at ~7 days. - First otoscopic exam at 3 weeks. - 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. --- ## About This Note This note on Cortical Mastoidectomy is one of the free ENT study notes published by The ENT Resident. It is free to read on the website, and it is paired with a full video lecture on YouTube. This note is categorized under [Otology](https://www.theentresident.com/ent-notes-lectures/category/otology.md) and [Surgery](https://www.theentresident.com/ent-notes-lectures/category/surgery.md). Each category page lists all the free ENT notes on that topic. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/cortical-mastoidectomy When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## About The ENT Resident The ENT Resident is a free library of ENT notes and video lectures created by Dr. Mausumi Das (MS ENT), the ENT doctor and educator behind The ENT Resident YouTube channel (https://www.youtube.com/c/TheENTResident). These notes are written for ENT residents, ENT postgraduates preparing for exams, and MBBS students, to help them learn ENT clearly and score well. 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Other contact options are on the contact page: https://www.theentresident.com/contact.md ## Related ENT Notes & Lectures #### Otology - [Abscesses in relation to Mastoid](https://www.theentresident.com/ent-notes-lectures/mastoid-abscess-bezold-citelli.md) - [Acute Mastoiditis VS Furunculosis](https://www.theentresident.com/ent-notes-lectures/acute-mastoiditis-furunculosis.md) - [Acute Necrotizing Otitis Media](https://www.theentresident.com/ent-notes-lectures/acute-necrotizing-otitis-media.md) - [Acute Otitis Media - Causes, Symptoms and Treatment](https://www.theentresident.com/ent-notes-lectures/acute-otitis-media-symptoms-treatment.md) - [Anatomy of External Ear](https://www.theentresident.com/ent-notes-lectures/external-ear-anatomy.md) - [Anatomy of Facial Nerve](https://www.theentresident.com/ent-notes-lectures/facial-nerve-anatomy.md) - [Anatomy of Facial Nerve – Branches](https://www.theentresident.com/ent-notes-lectures/facial-nerve-branches.md) - [Anatomy of Facial Nerve – Functional Components](https://www.theentresident.com/ent-notes-lectures/facial-nerve-functional-components.md) - [Anatomy of Facial Nerve – Nuclei & Course](https://www.theentresident.com/ent-notes-lectures/facial-nerve-course.md) - [Anatomy of Inner Ear](https://www.theentresident.com/ent-notes-lectures/inner-ear-anatomy.md) - [Anatomy of Middle Ear - Contents](https://www.theentresident.com/ent-notes-lectures/middle-ear-anatomy-contents.md) - [Anatomy of Middle Ear - Walls & Parts](https://www.theentresident.com/ent-notes-lectures/middle-ear-anatomy-walls.md) - [Anatomy of Tympanic Membrane](https://www.theentresident.com/ent-notes-lectures/tympanic-membrane-anatomy.md) - [Benign Intracranial Hypertension (Otitic Hydrocephalus)](https://www.theentresident.com/ent-notes-lectures/benign-intracranial-hypertension-otitic-hydrocephalus.md) - [Canal wall Down VS Canal wall Up Mastoidectomy](https://www.theentresident.com/ent-notes-lectures/canal-wall-down-up-mastoidectomy.md) - [Cholesteatoma](https://www.theentresident.com/ent-notes-lectures/cholesteatoma-symptoms-treatment.md) - [Chronic Suppurative Otitis Media (CSOM)](https://www.theentresident.com/ent-notes-lectures/chronic-suppurative-otitis-media.md) - 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[Sigmoid Sinus Thrombosis](https://www.theentresident.com/ent-notes-lectures/sigmoid-sinus-thrombosis.md) - [Theories of Cholesteatoma - Wittmack, Habermann, Ruedi, Sade](https://www.theentresident.com/ent-notes-lectures/cholesteatoma-theories-wittmack-sade-habermann-ruedi.md) - [Tos Classification - Pars Flaccida Retraction](https://www.theentresident.com/ent-notes-lectures/tos-classification.md) - [Tympanoplasty Part 1 - Definition, Types, Grafts, Indications, Contraindications](https://www.theentresident.com/ent-notes-lectures/tympanoplasty-types-indications-contraindications.md) - [Tympanoplasty Part 2 - Approaches, Techniques, Steps & Complications](https://www.theentresident.com/ent-notes-lectures/tympanoplasty-approaches-techniques-steps.md) - [Types of Cholesteatoma - Congenital & Acquired Cholesteatoma](https://www.theentresident.com/ent-notes-lectures/cholesteatoma-types-congenital-acquired.md) - [Types of Tympanoplasty - Wullstein Classification](https://www.theentresident.com/ent-notes-lectures/types-of-tympanoplasty.md) #### Surgery - 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[Tracheostomy - Procedure, Steps & Postoperative care](https://www.theentresident.com/ent-notes-lectures/tracheostomy-procedure-steps-postoperative-care.md) - [Tympanoplasty Part 1 - Definition, Types, Grafts, Indications, Contraindications](https://www.theentresident.com/ent-notes-lectures/tympanoplasty-types-indications-contraindications.md) - [Tympanoplasty Part 2 - Approaches, Techniques, Steps & Complications](https://www.theentresident.com/ent-notes-lectures/tympanoplasty-approaches-techniques-steps.md)