[PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 ·...
Transcript of [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 ·...
![Page 1: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/1.jpg)
C.S.O.M.: Mastoidectomy
Dr. Vishal Sharma
![Page 2: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/2.jpg)
Schwartze’s Cortical Mastoidectomy
![Page 3: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/3.jpg)
Middle ear cleft (Right)
![Page 4: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/4.jpg)
Cortical Mastoidectomy
![Page 5: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/5.jpg)
Boundaries of cavity
• Superior: Dural or Tegmen plate
• Anterior: Posterior wall of external auditory canal
• Inferior: Digastric ridge
• Posterior: Sigmoid sinus plate
• Medially: Lateral semicircular canal
![Page 6: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/6.jpg)
Normal temporal bone (right)
![Page 7: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/7.jpg)
Cortical Mastoidectomy
![Page 8: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/8.jpg)
Indications
![Page 9: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/9.jpg)
1. Coalescent mastoiditis & Masked mastoiditis2. CSOM T.T.D. active refractory to antibiotics3. Secretory otitis media refractory to antibiotics4. Approach to:
Endolymphatic sac surgery Facial nerve decompression Vestibulo-cochlear nerve section Translabyrinthine approach for C.P. angle Cochlear implant surgery Combined approach tympanoplasty
![Page 10: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/10.jpg)
Antiseptic dressing
![Page 11: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/11.jpg)
Draping
![Page 12: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/12.jpg)
Infiltration with Lignocaine
![Page 13: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/13.jpg)
Marking of incision
![Page 14: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/14.jpg)
Wilde’s post-aural incision
![Page 15: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/15.jpg)
Incision deepened till periosteum
![Page 16: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/16.jpg)
Musculo-periosteal flap elevated
![Page 17: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/17.jpg)
Bezold’s abscess
![Page 18: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/18.jpg)
Aspiration of pus
![Page 19: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/19.jpg)
Drainage of abscess
![Page 20: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/20.jpg)
Drainage of abscess
![Page 21: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/21.jpg)
Corical mastoidectomy begun
![Page 22: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/22.jpg)
Exposure of mastoid antrum
![Page 23: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/23.jpg)
Widening of aditus
![Page 24: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/24.jpg)
Aditus widened
![Page 25: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/25.jpg)
Final Cavity (right)
![Page 26: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/26.jpg)
Final Cavity (left)
![Page 27: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/27.jpg)
Drain put in mastoid cavity
![Page 28: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/28.jpg)
Mastoid dressing
![Page 29: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/29.jpg)
Healed post-aural scar
![Page 30: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/30.jpg)
Treatment for Attico-antral disease
![Page 31: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/31.jpg)
Topical ear drops + frequent suction clearance
Indications:
1. Early disease with shallow retraction pocket
2. Only hearing ear with cholesteatoma
3. Elderly patients
4. Pts who are not fit for surgery under G.A.
5. Pts who can regularly come for follow up
Medical Treatment
![Page 32: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/32.jpg)
Canal Wall down:
• Attico-antrostomy
• Modified Radical Mastoidectomy (MRM)
• Radical Mastoidectomy
Canal Wall up:
• Combined Approach Tympanoplasty (CAT)
Surgical Treatment
![Page 33: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/33.jpg)
Mac Ewan’s triangle
![Page 34: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/34.jpg)
Canal Wall Up Mastoidectomy
![Page 35: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/35.jpg)
Canal Wall Down Mastoidectomy
![Page 36: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/36.jpg)
Middle ear cleft
![Page 37: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/37.jpg)
Attico-antrostomy
![Page 38: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/38.jpg)
Modified Radical Mastoidectomy
![Page 39: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/39.jpg)
Pre-operative Anatomy
![Page 40: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/40.jpg)
Cortical Mastoidectomy done
![Page 41: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/41.jpg)
Modified Radical Mastoidectomy
![Page 42: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/42.jpg)
Surgical Steps
![Page 43: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/43.jpg)
• Perform cortical mastoidectomy
• Lower facial ridge & break facial bridge
• Remove cholesteatoma & granulations from
mastoid air cells & middle ear cavity
• Preserve healthy mucosa, T.M. remnant & ossicles
• Mastoid cavity & E.A.C. become a single cavity
seperated by middle ear cavity
• Perform tympanoplasty. Do concho-meatoplasty.
![Page 44: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/44.jpg)
Antiseptic dressing
![Page 45: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/45.jpg)
Draping
![Page 46: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/46.jpg)
Infiltration
![Page 47: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/47.jpg)
Infiltration
![Page 48: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/48.jpg)
Marking of incision
![Page 49: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/49.jpg)
Wilde’s post-aural incision
![Page 50: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/50.jpg)
Wilde’s post-aural incision
![Page 51: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/51.jpg)
End-aural incision
![Page 52: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/52.jpg)
Incision deepened till periosteum
![Page 53: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/53.jpg)
Incision deepened till periosteum
![Page 54: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/54.jpg)
Temporalis fascia graft
![Page 55: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/55.jpg)
Periosteum incised
![Page 56: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/56.jpg)
Periosteal flap elevated
![Page 57: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/57.jpg)
Mastoid cortex exposed
![Page 58: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/58.jpg)
Posterior canal wall incision
![Page 59: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/59.jpg)
Posterior canal wall vascular strip
![Page 60: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/60.jpg)
Vascular strip retracted laterally
![Page 61: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/61.jpg)
Drill cuts on mastoid cortex
![Page 62: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/62.jpg)
Corical mastoidectomy begun
![Page 63: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/63.jpg)
Cholesteatoma in mastoid cavity
![Page 64: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/64.jpg)
Exposure of mastoid antrum
![Page 65: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/65.jpg)
Widening of aditus
![Page 66: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/66.jpg)
Aditus widened
![Page 67: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/67.jpg)
Cortical mastoidectomy cavity
![Page 68: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/68.jpg)
![Page 69: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/69.jpg)
Facial ridge lowering started
![Page 70: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/70.jpg)
Breaking of facial bridge
![Page 71: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/71.jpg)
Elevation of tympanomeatal flap
![Page 72: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/72.jpg)
Elevation of tympanomeatal flap
![Page 73: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/73.jpg)
Removal of cholesteatoma over lateral SCC
![Page 74: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/74.jpg)
Retrofacial & labyrinthine cells removed
![Page 75: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/75.jpg)
Incudo-stapedial joint separated
![Page 76: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/76.jpg)
Malleus head nipped off
![Page 77: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/77.jpg)
Tensor tympani tendon cut
![Page 78: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/78.jpg)
Cholesteatoma removal from attic
![Page 79: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/79.jpg)
Exposure of sinus tympani
![Page 80: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/80.jpg)
ET orifice plugged with malleus head
![Page 81: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/81.jpg)
MRM cavity
![Page 82: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/82.jpg)
MRM cavity (ossicles preserved)
![Page 83: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/83.jpg)
Sites of facial nerve injury
![Page 84: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/84.jpg)
Korner’s meatoplasty incision
![Page 85: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/85.jpg)
Flap elevated
![Page 86: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/86.jpg)
Conchal cartilage cut
![Page 87: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/87.jpg)
Flap sutured posteriorly
![Page 88: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/88.jpg)
Healed Concho-meatoplasty
![Page 89: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/89.jpg)
Post-aural incision closed
![Page 90: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/90.jpg)
Radical Mastoidectomy
![Page 91: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/91.jpg)
Radical Mastoidectomy
![Page 92: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/92.jpg)
Surgical Steps
![Page 93: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/93.jpg)
• Perform cortical mastoidectomy. Lower facial ridge
& break facial bridge. Remove cholesteatoma &
granulations from mastoid air cells & middle ear.
• Remove normal middle ear mucosa, T.M. remnant &
ossicles (except stapes footplate).
• Close Eustachian tube opening. No tympanoplasty
done. Concho-meatoplasty performed.
• Mastoid, E.A.C. & middle ear become single cavity.
![Page 94: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/94.jpg)
Indications1. CSOM attico-antral disease with
Intra-cranial complication
Recurrence after modified radical mastoidectomy
Profound sensori-neural hearing loss (?)
2. Limited malignancy of middle ear
3. Glomus jugulare
4. Osteomyelitis of temporal bone
![Page 95: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/95.jpg)
Causes of discharging mastoid
cavity
![Page 96: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/96.jpg)
1. Inadequate concho-meatoplasty2. Recurrence of cholesteatoma 3. Residual cholesteatoma: facial ridge, facial
bridge, anterior + posterior buttress, mastoid tip, sinus tympani, anterior epitympanum
4. Persistent infection: petrositis, T.B., sinusitis
5. Persistent allergy6. Retained foreign body: cotton ball
7. Persistent extra-dural abscess8. Wrong indication
![Page 97: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/97.jpg)
Combined Approach Tympanoplasty
![Page 98: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/98.jpg)
Surgical Steps
1. Cortical Mastoidectomy
2. Anterior tympanotomy: via tympano-meatal
flap
3. Posterior tympanotomy: via facial recess
4. Tympanoplasty
![Page 99: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/99.jpg)
Cortical Mastoidectomy
![Page 100: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/100.jpg)
Anterior Tympanotomy
![Page 101: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/101.jpg)
Posterior Tympanotomy
![Page 102: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/102.jpg)
Tympanoplasty
![Page 103: [PPT]PowerPoint Presentation - The Medical Post | Trusting · Web view2011/02/12 · Dr. Vishal Sharma Schwartze’s Cortical Mastoidectomy Middle ear cleft (Right) Cortical Mastoidectomy](https://reader031.fdocuments.in/reader031/viewer/2022021504/5aac7bf87f8b9a8d678cf81c/html5/thumbnails/103.jpg)
Thank You