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.

1. TEN COMMANDMENTS OF
REVISION MASTOID SURGERY
Dr. Prahlada N.B
Karnataka ENT Hospital &
Research Center ®
Chitradurga, Karnataka, India

2. 1 FIRST QUESTION
IS IT REVISION?

3. 2 SITUATIONS: REVISION WHEN?
LATE
REVISION?
EARLY
REVISION ?

4. EARLY REVISION
• REVISION ON FIRST POST-OP DAY
• Iatrogenic Facial nerve paralysis
• SNHL
• Severe Vertigo
• Severe pain
• Bleeding
• High unexplained fever,

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. 4 PREVIOUS CLINICAL DETAILS
Previous
discharge
summary ?
Is facial nerve
completely
normal ?
Hearing status
before Ist
surgery ?
Previous
radiological
details ?

7. 5 PRE-OP WORK UP
Examination
of patient
expectation
s?
Radiological
examination
Otomicorscopic
examination
?
Facial nerve
examination
?
Audiological
examination

8. Dehiscent
jugular?
6 PROBLEMS
Dehiscent
wall of
EAC?
Dehiscent
dural
plate?
Dehiscent
oval
window?
Dehiscent
facial
canal?
Dehiscent
LSC?

9. 7 LANDMARKS
Dural plate
Sinus plate
LSC
Cochleoriform
process
Eustachian tube
Round
window
Cog

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. 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. 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. VIDEO

14. THANK YOU
prahladnb@gmail.com
www.kenthospitals.com