Mastoid Obliteration and Ear Canal Reconstruction

Mastoid Obliteration

• Mastoid obliteration is a surgical technique designed to close the open space within the mastoid bone after ear surgery.
• The procedure involves using bone pate, often harvested from the mastoid itself, synthetic materials, or soft tissue to fill the mastoid cavity.
• The goal of mastoid obliteration is to prevent recurrent ear infections and improve hearing by creating a solid, closed space within the mastoid.
• The technique of mastoid obliteration was revived in 1958 by Rambo, who used a temporalis muscle flap to cover the mastoid cavity.

Ear Canal Wall Reconstruction

• Techniques for reconstructing the posterior canal wall aim to prevent water from entering the mastoid cavity and to promote better hearing.
• Various techniques, such as temporalis muscle flaps, bone pate, and synthetic materials, have been used to reconstruct the posterior canal wall.
• While synthetic materials can be readily available and easy to use, they are more prone to extrusion or tissue breakdown compared to soft tissue, autogenous cartilage, or bone techniques.

Electromyography

• Botulinum toxin (BT) injections are often used to treat spasmodic dysphonia (SD), a condition where the vocal cords spasm.
• The majority of patients with SD are diagnosed with adductor SD, where the vocal cords close too tightly, leading to a strained, strangled voice.
• BT injections are typically given into the thyroarytenoid muscle for adductor SD and the posterior cricoarytenoid muscle for abductor SD.
• Electromyography (EMG) guidance can help direct BT injections to the most active areas of involved muscles, potentially improving the effectiveness of treatment.

Emergency Airways

• Awake intubations are used in situations where general anesthesia is too risky and the patient needs a secure airway.
• The use of a local anesthetic to block the recurrent laryngeal nerve allows for a painless and less stressful insertion of the endotracheal tube.
• The sniffing position, where the patient's chin is raised and the head tilted back, optimizes the airway and facilitates successful intubation.
• Blind intubations are done when the endotracheal tube cannot be directly visualized; this technique requires connecting the end of the endotracheal tube to itself to ensure that the tube remains open and unobstructed.

This quiz explores the surgical techniques of mastoid obliteration and posterior canal wall reconstruction. Learn about the materials and methods used in these procedures, including the historical context of mastoid obliteration. Understand the goals of preventing infections and improving hearing within ear surgery.