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| Name | LEFT REVISION CANAL WALL DOWN MASTOIDECTOMY WITH BOOMERANG OSSICULOPLASTY AND CAVITY OBLITERATION |
| Video Uploader | Video From Dr Meenesh Juvekar - ENT Doctor in Mumbai |
| Upload Date | This Video Uploaded At 10-01-2024 03:54:18 |
| Video Discription | CANAL WALL DOWM MASTOIDECTMY Mastoidectomy is a classic procedure for the treatment of middle ear and mastoid lesions. Its purpose is to debride lesions of the middle ear and mastoid; connect the external auditory canal, mastoid, tympanic cavity, and antrum into single a large cavity; and achieve a dry ear. Unfortunately, hearing reconstruction is often ignored when performing mastoidectomy. With the development of new technologies, canal wall down and canal wall up mastoidectomy along with tympanoplasty have become the main methods by which to treat middle ear or mastoid lesions. For patients with a wide range of lesions in the middle ear or mastoid cavity and for patients with mastoid dysplasia, canal wall down mastoidectomy is an effective treatment option. Mastoid obliteration and plastic repair of the cavity of the concha, which expands the external auditory meatus orifice for adequate ventilation of the open mastoid cavity, can achieve a dry ear in the early period. Reconstruction of the posterior and superior canal wall and ossiculoplasty have become the mainstream surgical techniques with which to improve hearing.However, many problems still remain, such as a narrow auditory meatus orifice after canal wall down mastoidectomy, a high facial ridge, a recurrent or residual cholesteatoma, and residual air cells, because of great differences among clinicians in the understanding of ear microscopy, temporal bone anatomy, pathophysiology, and disease prognosis.Surgical failure is more frequent in patients with more severe disease; with residual tegmental, apical, and sinodural cells causing persistent or intermittent ear discharge; and with hearing loss after both canal wall up and canal wall down mastoidectomy as the initial procedures, which prompts them to seek irregular long-term treatment and results in great economic and psychological burdens.Therefore, development of revision surgery techniques is urgently needed. BOOMERANG OSSICULOPLASTY Ossiculoplasty using tragal cartilage in the form of boomerang as an option for total ossicular replacement in absence of stapes superstructure. In this technique, the vertical strut is fashioned as a boomerang and measures 10 mm in length and 2 mm in breadth. A partial thickness cut is made on the vertical strut at 4–4.5 mm along the length so that it can be bent into boomerang, one end of which is placed on the stapes footplate and the other part rests in the hypotympanum. This stable assembly is placed on the footplate of the stapes (when all ossicles are absent). Boomerang ossiculoplasty is good option in cases of absent stapes providing a stable assembly. MASTOID CAVITY OBLITERATION The concept of mastoid obliteration was first introduced in 1911 by Mosher to promote healing of a mastoidectomy defect. Over the course of this century, there have been numerous reports detailing a variety of techniques of obliterating the mastoid cavity. The vast majority of obliteration techniques consist of either local flaps (muscle, periosteum, or fascia) or free grafts (bone, cartilage, hydroxyapatite, and so on). Mosher's original description was that of a superiorly based postauricular soft tissue flap. Kisch described the use of a pedicled temporalis muscle flap that was expanded on by Rambo. Popper described the use of a periosteal flap used to line, rather than obliterate, the mastoid cavity. Palva went on to describe a modification of Popper's flap as a musculoperiosteal flap to obliterate the mastoid bowl. Palva further added the use of bone chips and bone paté in combination with a musculoperiosteal flap. In addition to bone paté, other materials that have been described as implants for mastoid obliteration include fat grafts, diced cartilage, fascia, bone chips, and ceramic materials such as hydroxyapatite. Dr. Meenesh Juvekar (INDIA) M.S (ENT), D.N.B, D.O.R.L, M.N.A.M.S An ENT surgeon of international repute, Dr Meenesh Juvekar completed his MS (Master of Surgery) in ENT from the renowned LMT Medical College, Mumbai in January 1999. He has to his credit, numerous academic achievements some of which include the first place in DNB Examinations of National Board, New Delhi held in May 1999 – he was awarded the Kameshwaran Gold medal for standing first in India. He also secured the third place in MS (ENT) Examination of Bombay University in January 1999. Currently Dr Meenesh Juvekar is Consultant ENT Surgeon at Bombay Hospital, Mumbai and at Juvekar Nursing Home, Mumbai. He is also Consultant at Fortis Hospital, Mulund. Additionally, Dr Juvekar became the President – Association Of Otolaryngologists – Mumbai at a very young age. He also organised a conference in Hong Kong in the Golden Jubilee Year. He is ex-Associate Professor and Unit Head of Department of ENT at K.J. Somaiya Medical College & Hospital, Mumbai. |
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