--- title: "Cortical Mastoidectomy" description: "ENT notes on Cortical Mastoidectomy - Definition, Aims, Indications, Contraindications, Procedure and Post operative care." source: "The ENT Resident" author: "Dr. Mausumi Das" 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 ENT notes on Cortical Mastoidectomy - Definition, Aims, Indications, Contraindications, Procedure and Post operative care. 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 free ENT note on Cortical Mastoidectomy was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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