---
title: "Modified Radical Mastoidectomy"
description: "ENT notes on Modified Radical 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/modified-radical-mastoidectomy"
categories: ["Otology", "Surgery"]
video: "https://www.youtube.com/watch?v=K22Xg-eJ9wQ"
image: "https://media.theentresident.com/og-images/modified-radical-mastoidectomy.png"
---

# Modified Radical Mastoidectomy

ENT notes on Modified Radical Mastoidectomy - Definition, Aims, Indications, Contraindications, Procedure and Post operative care. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=K22Xg-eJ9wQ

## 🦻 Modified Radical Mastoidectomy (MRM)

### 📌 Definition of Modified Radical Mastoidectomy

**Modified Radical Mastoidectomy (MRM)** is a **canal-wall-down** procedure in which:  
- The **posterior meatal wall** and **lateral attic wall** are removed.  
- The **mastoid cavity** and **external auditory canal (EAC)** are converted into a single cavity.  
- **Tympanic membrane remnants**, **functioning ossicles**, and **Eustachian tube function** are **preserved**.  

🔑 It is a modified version of **Radical Mastoidectomy** - where all middle ear structures are removed and the ear is rendered non functional.

>What are the aims of Modified Radical Mastoidectomy?

>What are other canal wall down procedures you know?

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### 🩺 Indications of Modified Radical Mastoidectomy

- Resectable cholesteatoma  

- **Recurrent/residual cholesteatoma** after CWU surgery (e.g., cortical mastoidectomy)

- **Chronic otitis media (mucosal type)** with complications 

- **Only hearing ear** with cholesteatoma 

>What is unresectable cholesteatoma?

---

### ⛔ Contraindications of Modified Radical Mastoidectomy

- **COM without cholesteatoma** → prefer canal-wall-up surgery (cortical mastoidectomy).  

- **Medically unfit patient** (general anesthesia risk).  

- **Limited attic disease** in a reliable patient → attempt cortical mastoidectomy instead.  

>Is active ear discharge a contraindication of Cortical Mastoidectomy?

---

### 💉 Anaesthesia & Position
- **General anaesthesia**.  
- Patient **supine**, face turned to opposite side, ear to be operated facing upward.

---

### 🛠️ Operative Steps of Modified Radical Mastoidectomy

**1. Incision & Exposure**

- **Wilde’s post-auricular incision**: curved, 1 cm behind & parallel to retroauricular sulcus.  

- Deepen incision → periosteum → **T-shaped periosteal incision** (horizontal along linea temporalis + vertical to mastoid tip).  

- Elevate periosteum, retract with Mollison’s → expose mastoid cortex.

**2. Cortical Mastoidectomy Steps**

- Identify **McEwan’s (suprameatal) triangle** → antrum lies ~12–15 mm deep.  

- Drill mastoid cortex.  

- Exenterate mastoid, zygomatic, retrosinus cells → reach mastoid tip & expose digastric ridge.  

**3. MRM-Specific Steps**

- Atticotomy

- Preserve canal wall skin

- Remove facial bridge
 
- Remove anterior buttress

- Remove posterior buttress

- Lower facial ridge
 
- Exenterate all disease** (epitympanum, aditus, sinus tympani, facial recess, mesotympanum)

- Saucerize cavity → smooth, shallow bowl for epithelialization & self-cleansing.  

- Reconstruct hearing (ossiculoplasty, cartilage grafts, tympanoplasty).  

- Meatoplasty → widen EAC via pinna to allow post-op cavity access, ventilation & self-cleansing.  

- Reposition skin flap

- Close wound in 2 layers + mastoid dressing.

>What are the limits of Modified Radical Mastoidectomy?

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### 🩹 Post-operative Care of Modified Radical Mastoidectomy

- Mastoid dressing removed after **24–48 hrs**.  

- **Keep ear dry**; strict water precautions × 6 weeks.  

- Antibiotics & analgesics × 7 days.  

- **Sutures out** after 7 days.  

- First **otoscopic exam** at 3–4 weeks → clean granulations if present.  

- **Audiometry** at 6–8 weeks.  

- Plan **second-stage ossiculoplasty** if needed.

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## About This Note

This free ENT note on Modified Radical Mastoidectomy was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/modified-radical-mastoidectomy

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

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- Surgery: https://www.theentresident.com/ent-notes-lectures/category/surgery.md

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