37 cases of radical mastoidectomy ear can not do cause analysis and preventive measures
【Abstract】 Objective To investigate the radical
mastoidectomy ear can not do the causes and preventive measures. Methods The subjects were treated from 1990 to 2005
of 37 cases of radical mastoidectomy can not do ear mastoid surgical findings in patients with re-analysis of parallel
second (or three or four) Radical mastoidectomy. Results 1 to 3 months in patients with previous symptoms, dry ear.
Conclusion radical mastoidectomy failed mainly due to middle ear and mastoid surgery were not familiar with anatomy, basic, but hard, lack of clinical experience led to lesions residues, poor drainage and mastoid tip opening due to inadequate and in
some special cases. Completely remove the lesion surgery to ensure smooth drainage and special circumstances after the treatment is to prevent the second operation key.
Key words radical mastoidectomy; preventive measures
Causes of failure of 37 patients treated with revision
mastoidectomy and precautions
CHEN Bing.Yibin Second People's Hospital, Yibin 644000, China
[Abstract] Objective To explore the failure causes of
mastoidectomy and precautions.Methods The operation findings
of 37 cases who underwent revision mastoidectomy from 1995 to 2005 were analyzed for causes of the primary procedures and revision mastoidectomy failure.Results Original symptoms disappeared.All cases achieved a dry ear after mastoidectomy 1 ~ 3 months.Conclusion Causes of failure of mastoidectomy include unfamiliarity with regional anatomy, absence of skill of surgeons, unadequate opening of mastoidale, and clinical experiences.Each of these can result in residual lesion and inadequate drainage.Some exceptions can also result in
reoperation.To resect the pathological changes tissue thoroughly, to remain good drainage after operation, to manage some execptions are keys to prevent reoperation.
[Key words] mastoidectomy; precaution
Radical mastoidectomy is a routine ENT surgery, the aim is to clear the middle ear and mastoid lesion, and was dry ear. I Bureau since 1985 to 2005 a total failure of radical mastoidectomy in patients treated 42 cases. Collection of information is now complete in 37 cases, according to the
situation seen in the original operative mastoid ear surgery can not do analysis of the causes and propose preventive measures.
A clinical data
1.1 General Information of this group of 37 cases (37 ears), the male 24 cases, female 17 cases; age from 14 to 65 years old, OK mastoidectomy surgery still intermittent or persistent ear pus 33 cases, pus associated with vertigo in 4 cases, again from the previous mastoid surgery operative time, up to 15 years and the shortest 6 months; the second line of
radical mastoidectomy in 33 cases, three times in 3 cases, four times in 1 case. Initial mastoid surgery, 34 cases of radical mastoidectomy, radical mastoidectomy plus three cases of tympanoplasty.
1.2 Methods 37 cases of patients with all the lines
again, radical mastoid surgery. Anesthesia options: general anesthesia in 21 cases, 16 cases of local anesthesia booster; incision: According to the CT to determine line of ear or in ear incision. Intraoperative findings: (1) lesions are not
completely clear, there is one or more residual lesions, of which the latter tympanic (tympanic facial recess and after) 15 cases, 7 cases of attic is mainly an open air room is not enough; sinus meningeal angle in 2 cases; mastoid tip, 9; of
the facial nerve around the residual disease in 2 cases; eustachian tube mouth is not closed in 2 cases; (2) operation is not in place to operate, the high ridge of the facial nerve in 18 cases, both before and after a high arch column in 2 cases, no broken bridge 1 case, bone wall to open incomplete in 7 cases, the mastoid cavity 7 cases of bad shape. From the nature of the analysis of lesions: (1) recurrence of cholesteatoma l5 patients with labyrinth fistula holes in 4 cases, the recurrence time of the most short-range surgery the
previous 6 months, a maximum of 4 years; (2) All 37 cases of varying degrees of granulation and viscous purulent secretions; (3) mastoid cavity left by a cotton bandage l cases; (4) crossing a narrow seven cases of ear, which due to
physical scar after scar Erzhi narrow entrance of the Ministry of 1 case, after the incision line of the middle ear ear radical mastoidectomy ear ear without making a cavity angioplasty in 5 cases; (5), middle ear tuberculosis in 1 case. Completely clear the lesion surgery, facial neural crest to maintain low enough, there are three routine skin grafting.
1.3 Results All patients 3 months after a dry ear. Radical surgery again, two cases of facial paralysis occurs, for late-onset facial paralysis, in the 3 months to resume, one cases of petrous cholesteatoma postoperative cerebrospinal fluid leakage. 7 days to stop. Auricular perichondritis one cases of cured, there are ear on the left 1 / 3 of deformity. Limitations lost 2 cases, after 7 days, dizziness, vomiting
disappeared. 37 cases of re-line the mastoid caused by radical
surgery without deaf persons.
2.1 The main reason for the failure of radical
mastoidectomy usually caused by middle ear and mastoid surgery
were not familiar with anatomy, basic, but hard, residual lesions caused by lack of clinical experience. Apart from individual cases in this group almost all the result of lesions outside the residual, discharging more than the re-
operation; analysis of residual lesion site, mostly in the
facial nerve, sigmoid sinus, lost and other important organs in the vicinity, such as the posterior tympanum, attic, around the facial nerve and facial nerve recess, sinus, etc. meninges angle. Members Pang et al  reported that, because focal
cleaning is not complete, residual lesions were as high as room air 65.8%, especially sinus meninges angle, mastoid tip more common; position posterior tympanum concealed, in particular, because of the post-tympanic sinus is located in
the facial nerve deep and difficult to detect. Attic depth, size, and the entrance marked variation, especially in the front of the attic with a large easy legacy crypt foci. After the tympanic sinus tympanic cavity can be divided into post-
tympanic sinus and facial recess and the lateral sinus four parts, an average depth of 0.7 cm, with the facial nerve close to here, and sometimes in-depth behind the facial nerve, where Yi residual disease. In this group of residual lesions after the attic and attic majority, showing that patients were not familiar with the above-mentioned anatomy, basic, but hard,
fear of post-operative complications occurred while the lesion is not full and complete clean-up the main reason for surgical
failure. Reposted elsewhere in the paper for free download
2.2 The basic operation of mastoid surgery is not in place, and poor drainage caused by lack of clinical experience in this group, 18 patients with facial neural crest is affected by high operative cavity ventilation and drainage and
post-operative dressing change observation of operative cavity. Facial neural crest undercutting standards : the medial section can not be less than the horizontal semicircular canal and incus fossa, external auditory canal
posterior wall of the outer end can be cut from under the wall in parallel with the external auditory canal. The surgeon just not well grasp this standard treatment, there are front and rear arches column high and those who have not broken bridge. Therefore, the necessary basic skills training is to reduce re-operation occurred in the basic requirements; surgery
incision improperly located within the middle ear, ear canal mouth stitched too tight, organized under the ear flap cut is not enough, but also factor in the postoperative ear canal
2.3 The lack of proper equipment to achieve good surgical purposes should have the ear with surgical microscope, an electric drill and other equipment. Only the application of ear surgery microscope, it is possible to the middle ear
cavity, tympanic sinus, facial nerve recess and mastoid air rooms and other diseased tissue removed. Application of electric drill to grind a low posterior ear canal wall neural crest, open from top to bottom tympanic, expanding drum sinus
ostium; can be polished to drum loop to remove the air hidden room, so that surgery cavity epithelization easy to obtain a dry ear. Therefore, do not have the ear of hospital surgical microscope, an electric drill should be careful to do radical
2.4 does not attach importance to postoperative care postoperative management of radical mastoidectomy has also contributed an important factor in dry ear, can not be ignored. The iodoform gauze packing cavity surgery is generally 14 days to be removed, some patients without bleeding and secretions, epithelial began to take shape, in the absence infection, most people can get a dry ear. But most cases occur a little bleeding and discharge, this time very important for post-operative treatment, applied disinfectant
swab carefully Shi Jing surgery cavity bleeding and discharge, if there is mucosal edema, granulation tissue, or residual disease, flaps and so on, must be seriously addressed, will flap reset, clear the lesions is available laser, microwave
irradiation, and then use hypertonic saline plus gentamicin gauze, appropriate pressure. If surgery is still a good cavity mucosa to form, and only a little discharge, may according to the results of bacterial culture, choose the appropriate
antibiotic otic preparations; if they discharge the round window can be used to fill the mucous membrane, or sarcolemma organization, or laser, microwave treatment filling pressure. Each Qing Shi operative cavity, the action should be gentle careful, can not be left behind, or cotton yarn, or hinder the formation of epithelium. To have an allergic reaction, or
fungal infection, should be timely processing. Mastoid operation cavity epithelization dry ear, every 3 to 6 months later a second, so that timely remove crusts, maintaining a
long-term dry ear.
2.5 Measures to reduce re-mastoid surgery (1) to
strengthen the basic theory, basic skills, learning and training to improve surgical skills. (2) surgery, the surgical creation of favorable conditions: ? full anesthesia the
patient pain-free, quiet. Section I generally use more general anesthesia, and tolerance of poor economic conditions, in patients with strong use of local anesthesia booster; ? 6 ~
10 times in the surgery under a microscope in order to obtain
a clear, bright surgical field. The vast majority of cases the initial group of radical mastoid operation was carried out in non-micro-surgery; ? adequate hemostasis and cleaning to
maintain a clean surgical field, so that patients are able to
see the subtle and important pathological changes in its structure will not be damaged, but also make lesions cleared. (3) strengthening postoperative treatment, after 2 ~ 3 weeks ruddy, flat and smooth gradually covered with granulation operative cavity, newborn epithelium gradually close up on it, if there is dark colored, flaccid yellow discharge accompanied by abnormal granulation to scrape and use prednisolone plus a small sensitive to antibiotic-impregnated gauze oppression and
pave the way to make new epithelium to prevent the formation of pits or compartments. To maintain the ears after crossing the original one ~ 1.5 times the surgery can not be ear incision suture too tight, in addition to the left wall of 0.3 ~ 0.5 cm incision is not stitched, you can also after the
removal of ear incision edges ear A cavity before the 0.2 ~ 0.3 cm of cartilage, so that ear crossing increased, dressing, every time has softened the entrance with the otoscope until epithelial healing, when dressing for skin grafting were not
rude, to prevent the formation of flaps roll up pouch , in the epithelium of all the operative cavity after 2 months or 6 months, regular review and timely clean-up crusts and the
accumulation of material is also one of the elements to prevent the re-operation. (4) The handling of special cases: ? in this group of middle ear tuberculosis cases are caused by secondary surgery in 1 case. Therefore, preoperative detailed history, preoperative, intraoperative bacterial culture of middle ear secretions increases susceptibility and
pathological examination is indispensable; ? end of surgery,
make sure that comprehensive inspection of the operative cavity, and resolutely to be left with foreign objects. The group, 1 case was caused by foreign body in mastoid cavity
cotton bandage second surgery, really should not be; ? on the
physical scars, could replace Dole's plant at the entrance to prevent skin graft stenosis, but also local injection of Kenacort A; ? occurred after Occult perilymphatic fistula,
radical surgery again, the identification of leak location, take temporalis myofascial closure of fistula hole; ? narrow
mouth of congenital external auditory canal can be a mastoid ear cavity after radical operation for plasty.
1 Pang, Zhao Quan-yi. Tympanic sinus surgery debridement. Chinese Journal of Otorhinolaryngology, 1984,19 (3): 167.
2 Jiang Sichang. Operative surgery volume Complete Works of otorhinolaryngology. Beijing: People's Medical Publishing House, 1996,114. Reposted elsewhere in the paper for free download http://