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Mastoidectomy is a fairly frequent procedure performed for a variety of temporal bone pathologies including mastoiditis and cholesteatoma. It involves removing part of the bony wall of the mastoid to aid in drainage and surgical excision.
Types of mastoidectomy
A number of procedures have been described, commonly divided into
"canal wall up" and
"canal wall down" mastoidectomies.
The lateral wall of the mastoid is removed. The posterosuperior wall of the external acoustic meatus is preserved 1. This approach does not allow visualization of the ossicular chain.
Canal wall up (closed) mastoidectomy
Similar to a simple mastoidectomy in that the lateral wall of the mastoid is removed and the posterosuperior wall of the external acoustic meatus is preserved 1. Additionally, Koerner's septum is removed which grants access to the middle ear cavity and allows the ossicles to be seen1.
Canal wall down (open) mastoidectomy
Similar to a canal wall up mastoidectomy in that the lateral wall of the mastoid is removed and Koerner's septum is removed creating a communication with the middle ear cavity 1. The main difference is that the posterosuperior wall of the external acoustic meatus is also removed 1. The tympanic membrane is usually reconstructed.
A modified canal wall down mastoidectomy is similar but does not manipulate the ossicular chain or the tympanic membrane.
Some of the more common complications include:
infection which may extend to the membranous labyrinth (labyrinthitis)
- 1. Mukherji SK, Mancuso AA, Kotzur IM et-al. CT of the temporal bone: findings after mastoidectomy, ossicular reconstruction, and cochlear implantation. AJR Am J Roentgenol. 1994;163 (6): 1467-71. doi:10.2214/ajr.163.6.7992748 - Pubmed citation
- 2. Amy F. Juliano, Daniel T. Ginat, Gul Moonis. Imaging Review of the Temporal Bone: Part II. Traumatic, Postoperative, and Noninflammatory Nonneoplastic Conditions. (2015) Radiology. doi:10.1148/radiol.2015140800