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is the removal of bone from the mastoid process. This
process is located behind the ear canal and contains air cells which drain
middle ear. There removal becomes necessary if they are
diseased or if a
cholesteatoma, an infected skin cyst in the
mastoid, is present.
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
nerves and the
blunt probe is often used to palpate areas to determine if they are mucosa
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
incus. If possible, the
is left intact.
head of the
malleusis removed by cutting the neck of the
is the attachment of the
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
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
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.
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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Kavanagh, All Rights Reserved
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