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