TEN COMMANDMENTS OF REVISION MASTOID SURGERYDr. Prahlada N.B

Karnataka ENT Hospital &

Research Center ®

Chitradurga, Karnataka, India

IS IT REVISION?

1 FIRST QUESTION

LATE

REVISION?

EARLY

REVISION ?

2 SITUATIONS: REVISION WHEN?

EARLY REVISION

• REVISION ON FIRST POST-OP DAY

• Iatrogenic Facial nerve paralysis

• SNHL

• Severe Vertigo

• Severe pain

• Bleeding

• High unexplained fever,

Is it to repair a

complication ?

Is to treat to improve

patients’ hearing?

Is it to treat

discharging ear ?

3 REASONS: WHY REVISION?

Previous

discharge

summary ?

Hearing status

before Ist

surgery ?

Previous

radiological

details ?

Is facial nerve

completely

normal ?

4 PREVIOUS CLINICAL DETAILS

Oto-

micorscopic

examination

?

Facial nerve

examination

?

Radiological

examination

Examination

of patient

expectation

s?

Audiological

examination

5 PRE-OP WORK UP

Dehiscent jugular?

Dehiscent dural

plate?

Dehiscent facial

canal?

Dehiscent LSC?

Dehiscent oval

window?

Dehiscent wall of EAC?

6 PROBLEMS

Dural plate

Sinus plate

LSC

Cochleoriformprocess

Eustachian tube

Round window

Cog

7 LANDMARKS

8 REASONS FOR RECURRENCEP –

Tegmencells

P – around Stapes Foot

plate

P - in Peri-tubal cells

P - in Retro-facial cells

P - in Tip cells

P - in SD angle

Pathology (P) - in Sinus tympani

High facial ridge

Lack of Graft

material

Persistent inflammation

Post-arualscar

tissue

Orientation in the middle ear

High jugular bulb

Dehiscent Carotid

Middle ear

adhesions

New bone

formation

Excessive

Bleeding

9 HURDLES

Palpate mastoid cortex

Delineate and drill dural plate

Delineate and drill sinus plate

Identify Lateral Semicircular

canal

Identify round window

Identify Cocheoriform

process

Cog

Oval window

Facial canal

Digastric Ridge

10 STEPS FLIGHT PLAN

VIDEO

THANK YOU

prahladnb@gmail.com

www.kenthospitals.com