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Ear - Otology - Surgical Instruments Course, Kevin Kavanagh

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Catherine Kavanagh, 
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A mastoidectomy is the removal of bone from the mastoid process.  This process is located behind the ear canal and contains air cells which drain into the middle ear.   There removal becomes necessary if they are diseased or if a cholesteatoma, an infected skin cyst in the middle ear and mastoid,  is present. 

The operation first involves exposure of the mastoid tip using a periosteal elevator and removal of the mastoid bone using a cutting bur.
The picture to the right shows a cutting burr with several flutes.  A wire brush will sometimes be required to remove bone dust from the flutes.   The picrure on the left shows a diamond burr which has been used during surgery.  Note the loss of some of the diamonds on the burr's head.  Diamond burrs are used in approaching vital structures such as the
inner ear
, nerves and the dura.

A blunt probe is often used to palpate areas to determine if they are mucosa containing
mastoid air cells or dura (the lining of the brain).

While the surgeon drills water irrigation will bathe the bone to prevent it from becoming burnt.   Some drills have water irrigation built into them, if not, suction irrigators will have to be used.  These are suctions with two ports one for suction and the other for water -- see picture on right.   The strength of the water flow is titrated with a valve.  A good rule of thumb is to let the water flow when the surgeon is drilling and clamp the water tube when the drilling stops.  Always clamp the tube rather than turning off the valve.  Otherwise you will have to re-titrate the water every time drilling restarts.
ossicles often have to be removed and joint knifes or a tab knife is used to remove the incus.  If possible, the stapes is left intact.

The head of the
malleusis removed by cutting the neck of the malleus.  The manubrium is the attachment of the malleus to the eardrum and this is not removed because to do so will often rip or damage the eardrum. 

At the end of the operation a
mastoid dressing is applied which consist of fluffs placed over the ear and held in place by Kerlix or Kling Gauze.  The most important thing to remember about a mastoid dressing is not to place it too tight or skin necrosis of the forehead and scalp may occur.

#1.  Cut a  4 X 4 gauze pad to fit over the auricle.

#2.  Place a cotten ball over the meatus.

#3.  Place the cut 4 X 4 gauze over the auricle.

#4.  Place a gauze over the forehead.

#5.  Place fluffs over the gauze pad.

#6.  Wrap Kerliz or Kling Gauze around the head.  DO NOT apply too tight or tissue necrosis may occur.

#7.  Tie the forehead gauze and wrapping gauze together.

Mastoid Dressing Skin Sore Caused by Too Tight Dressing Application#8.  Be very careful not to tie the dressing too tight or pressure necrosis of the skin can occur.  The picture on the right shows a young male who developed a skin sore in the location of the dressing's knot.  If left on longer the skin could have necrosed. 


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