Radical mastoid surgery-various aspects-
The aim of the radical procedure is to transform the external auditory canal, the middle ear, the attic, the antrum, and the mastoid into one interconnected open cavity. To achieve this, the mastoid antrum is accessed, the posterior wall of the bony canal that divides the middle ear from the mastoid is taken out, along with the malleus, incus, and tympanic membrane, and subsequently the diseased granulations are eliminated, merging these areas into a single cavity. The incision behind the ear is entirely sutured closed, and the postoperative care is administered through a widened membranous external auditory meatus. The radical cavity is maintained and cleaned daily until it is dry and fully dermatized.
The close connection of the middle ear and mastoid with the facial nerve, internal ear, jugular bulb, and other intracranial structures necessitates that the surgeon possesses practical knowledge of the surgical anatomy relevant to this procedure. Its success will then rely on meticulous and precise execution of the various stages involved in its technique.
THE STEPS OF THE RADICAL OPERATION
The stages that constitute the technique of the radical operation are detailed as follows:
The mastoid incision and exposure of the cortex
Access to the mastoid antrum
Removal of the posterior wall of the bony canal
Extraction of debris from the middle ear
Initial lowering of the facial ridge
Elimination of the external attic wall
Removal of the tympanic annulus
Curettage of the Eustachian tube
Final reduction of the facial ridge and exenteration of the hypotympanic space
Lowering of the floor and the anterior wall of the canal
Examination of the radical cavity
Trimming of the flap
Closure of the wound
