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Revision mastoid surgery

Ten commandments of Revision mastoid surgery prepared by Dr. Prahlada N.B is a presentation explaining indications for revision mastoid surgery, reasons for recurrence, hurdles for surgery, pre-operative evaluation required, landmarks for revision surgery and flight plan for revision surgery.

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Revision mastoid surgery

  1. 1. TEN COMMANDMENTS OF REVISION MASTOID SURGERY Dr. Prahlada N.B Karnataka ENT Hospital & Research Center ® Chitradurga, Karnataka, India
  2. 2. 1 FIRST QUESTION IS IT REVISION?
  3. 3. 2 SITUATIONS: REVISION WHEN? LATE REVISION? EARLY REVISION ?
  4. 4. EARLY REVISION • REVISION ON FIRST POST-OP DAY • Iatrogenic Facial nerve paralysis • SNHL • Severe Vertigo • Severe pain • Bleeding • High unexplained fever,
  5. 5. 3 REASONS: WHY REVISION? Is it to treat discharging ear ? Is to treat to improve patients’ hearing? Is it to repair a complication ?
  6. 6. 4 PREVIOUS CLINICAL DETAILS Previous discharge summary ? Is facial nerve completely normal ? Hearing status before Ist surgery ? Previous radiological details ?
  7. 7. 5 PRE-OP WORK UP Examination of patient expectation s? Radiological examination Otomicorscopic examination ? Facial nerve examination ? Audiological examination
  8. 8. Dehiscent jugular? 6 PROBLEMS Dehiscent wall of EAC? Dehiscent dural plate? Dehiscent oval window? Dehiscent facial canal? Dehiscent LSC?
  9. 9. 7 LANDMARKS Dural plate Sinus plate LSC Cochleoriform process Eustachian tube Round window Cog
  10. 10. 8 REASONS FOR RECURRENCE P– Tegmen cells 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
  11. 11. 9 HURDLES Middle ear adhesions Orientation in the middle ear Excessive Bleeding Postarual scar tissue Lack of Graft material Persistent inflammation New bone formation High jugular bulb Dehiscent Carotid
  12. 12. Palpate mastoid cortex Cog Facial canal Delineate and drill dural plate Identify Cocheoriform process Oval window Delineate and drill sinus plate Identify round window Identify Lateral Semicircular canal Digastric Ridge 10 STEPS FLIGHT PLAN
  13. 13. VIDEO
  14. 14. THANK YOU prahladnb@gmail.com www.kenthospitals.com

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