Hammer and gouge mastoidectomy for acute mastoiditis - Vula ...

This is continued until normal bone isencountered.Figure 26: Exposed boneThird Step: Exploration of the BoneKocher haemostats are applied to theperiosteal flaps and the portion of thetemporal muscle, which bleed freely.Ligatures are applied to the muscularvessels. Two hooked retractors are held bythe second assistant. The region being wellexposed, the surgeon examines it foralterations in color, form, and surface. Heverifies the areas of osteitis and thepossible presence of a fistula, which maybe located in the squama temporalis underthe muscle (deep temporozygomaticmastoiditis) or on the zygomatic archimmediately above the canal (superficialtemporozygomatic mastoiditis).Figure 27: Trephination done above theear canalFifth Step: Exploration and Cleansing ofthe Operative CavityThe cavity is explored with great rare. Allthe bony spicules, whether free or adherentare removed. The edges of the interior ofthe cavity are smoothed with the fineangular rongeur (Figure 28). Thesucceeding steps of this operation are thesame as those in the mastoidectomy.Fourth Step: TrephiningIf a complete mastoidectomy has beenperformed, systematic exploration iscarried out with a small gouge, startingfrom the antral region and including theentire base of the squamous bone, beingguided by the existing lesions. If themastoid is normal and if the radiologicaland clinical examinations have shownabsolute integrity of the antral system,trephination is done above the canal inorder to curette and cleanse the cavities ofempyema and osteitic foci (Figure 27).Figure 28: Final cavity12