Surgery steps
1.Position: take a flat position with the affected side up.
2. Routine disinfection, head wrapping and towel laying.
3.Anesthesia: 1% lidocaine plus 0.1% epinephrine for auriculotemporal, vagus and auricular nerve block anesthesia, subcutaneous infiltration anesthesia in the posterior mastoid area; 2% lidocaine plus 0.1% epinephrine for subcutaneous infiltration anesthesia in the four walls of the external auditory canal.
4. Make an incision, separate the skin and periosteum, and expose the bone: at the concave and shallow groove between the auricular cartilage and the external auditory canal cartilage, make an incision along the posterior wall starting from 6 o’clock upward to 12 o’clock, and extend 2 cm upward along the foot of the ear wheel, and cut the skin, subcutaneous tissue and periosteum. The periosteum is separated to expose the mastoid cortex, up to the inferior border of the temporalis muscle, down to the tip of the mastoid, anteriorly to the root of the zygomatic process, and posteriorly to the posterior wall of the external auditory canal about 2 cm. The mastoid retractor is placed to expose the mastoid sign, and the skin and periosteum of the posterior and superior walls of the external auditory canal are peeled away until the tympanic ring.
5. Remove the bone and enter the tympanic sinus and tympanic cavity.
A. Sieve zone approach: Starting from the posterior aspect of the posterior superior spine of the external auditory canal (sieve zone), chisel away the bone to enter the tympanic sinus, enlarge the opening of the tympanic sinus, and chisel away the bone of the lateral wall of the superior tympanic chamber through the entrance of the tympanic sinus to enter the superior tympanic chamber and expose the lesion.
B. Subcortical approach: About 5 mm inside the posterior superior spine of the external auditory canal, i.e., the intersection of the posterior and superior walls of the external auditory canal, chiseling inward and backward into the tympanic sinus, enlarging the opening of the sinus, and chiseling through the entrance of the sinus to remove the bone of the lateral wall of the superior tympanic chamber to enter the superior tympanic chamber and expose the lesion.
C. Upper tympanic ventricle approach: The skin and periosteum of the external auditory canal are peeled off to the point equivalent to the lateral wall of the upper tympanic ventricle. Under the probe probe, the tympanic sinus is chiseled open through the entrance of the tympanic sinus, which is completely open to expose the lesion.
6.Chisel open the lateral mastoid cortex and air chamber of the tympanic sinus.
7.Remove the lesion in the mastoid and bulbar sinus.
8.Bone bridge: After the lesions in the mastoid and tympanic sinus are cleared, the entrance to the tympanic sinus can be seen and the bone bridge can be cut. (forward need to reach the front edge of the lateral wall of the upper tympanic chamber, that is, completely open to reveal the upper tympanic chamber, do not leave a hidden fossa; backward to the level of the entrance of the tympanic sinus, the bottom of the entrance of the tympanic sinus shall not be left with raised bone, downward shall not be lower than the bottom of the entrance of the tympanic sinus, because its bottom has the facial nerve and horizontal semicircular canal)
9.Treatment of the tympanic chamber: After the bone bridge is removed, the tympanic chamber can be clearly seen, and the lesion inside the tympanic chamber is cleared.
10.Cut down the posterior wall of the external auditory canal and the facial nerve crest. (The medial section should not be lower than the horizontal semicircular canal and anvil fossa. The outer end of the posterior wall of the external auditory canal can be cut until it is parallel to the lower wall of the external auditory canal, and if there is bleeding from a small artery inside the bone, it means that the facial nerve canal is close to the facial nerve canal, because there is often a small artery inside the lateral bone wall of the facial nerve canal that is parallel to the facial nerve)
11.Cut the external auditory canal skin and form a flap: after rinsing the surgical cavity and thoroughly stopping bleeding, cut the external auditory canal skin flap from above, trim away its subcutaneous tissue and remove the cartilage of the external auditory canal, then flip it to the bottom posteriorly and lay it in the mastoid cavity.
12. Filling the operative cavity and suturing the incision: 10 iodoform gauze cut into segments are filled into the operative cavity, the incision is sutured, and the ear is wrapped with a dressing bandage under pressure.
[Surgical accident].
1.Fatal hemorrhage: Fatal hemorrhage due to anatomical abnormalities or intraoperative injuries, such as injury to the sigmoid sinus, mastoid conduction vessels, internal carotid artery, and jugular venous bulb.
2.Intraoperative and postoperative facial nerve palsy: that is, loss of facial expression movement, loss of frontal lines, inability to frown and close the eyes, shallowing of the nasolabial folds, skewing of the corners of the mouth down to the healthy side, tongue extension to the healthy side, air leakage from the gills and fluid leakage from the corners of the mouth, etc.
3.No dry ear and long-term pus flow in the ear after surgery.
4.Hearing loss or even total deafness after surgery.
5.Post-operative permanent vertigo.
6.Cerebrospinal fluid leakage: i.e. tympanic cap, tympanic sinus cap, dural injury causing cerebrospinal fluid leakage, or even meningeal hernia formation.
7.Intracranial infection, meningeal brain bulge.
8.Purulent auricular chondromyelitis formation, auricular deformity.
9, Labyrinthitis formation.
10, Incisional complications: bleeding, infection, hematoma, plasmacytoma, cracking, non-healing or delayed healing, fistula and sinus tract formation; local skin scarring or deformity, skin numbness around the incision.
11.Long-term drug change is required after surgery.
12.Abort the surgery.
13.In order to completely remove the lesion during the operation, cut the bulbar nerve or remove part or all of the auditory bone if necessary.
14.Decreased sense of taste after surgery.
15.Postoperative aggravation of the original disease.
16.Rare complications occur intraoperatively and postoperatively.
17.Send to pathology, the pathology is other.
18.Recurrence.
19.Postoperative infection.