A 30-year-old male is having Attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice
Attic cholesteatoma is an indication for modified radical mastoidectomy. (Canal wall down mastoidectomy) Surgical treatment of Atticoantral Cholesteatoma It is the mainstay of treatment. Primary aim in surgical treatment is to remove the disease and render the ear safe, and second in priority is to preserve or reconstruct hearing but never at the cost of the primary aim. Two types of surgical procedures are done to deal with cholesteatoma: (a) Canal wall down procedures. They leave the mastoid cavity open into the external auditory canal so that the diseased area is fully exteriorized. The commonly performed operations for atticoantral disease are atticotomy, modified radical mastoidectomy and rarely, the radical mastoidectomy (see operative surgery). (b) Canal wall up procedures: Here disease is removed by combined approach through the meatus and mastoid but retaining the posterior bony meatal wall intact, thereby avoiding an open mastoid cavity. It gives dry ear and permits easy reconstruction of hearing mechanism. However, there is danger of leaving some cholesteatoma behind. Incidence of residual or recurrent cholesteatoma in these cases is very high and there fore long-term follow-up is essential. Some surgeon's even advise routine re-exploration in all cases after 6 months or so. Canal wall up procedures are advised only in selected cases. In combined approach or intact canal wall mastoidectomy, disease is removed both permeatally, and through coical mastoidectomy and posterior tympanotomy approach, in which a window is created between the mastoid and middle ear, through the facial recess, to reach sinus tympani Ref : Diseases of ENT by Dhingra 6th edition Pgno : 73
Intact canal wall mastoidectomy
Mastoidectomy with cavity obliteration
Simple mastoidectomy with Tympanoplasty
Canal wall down mastoidectomy
Ear