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Thread: Mastoidectomy Cavity (Canal Wall Down) pictures - Ear Atlas

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    Default Mastoidectomy Cavity (Canal Wall Down) pictures - Ear Atlas

    [Canal Wall Down Mastoidectomy
    The CWD mastoidectomy is so named because the posterior (back) wall of the outer ear canal is removed during the operation. The back wall is removed to make the ear canal and the mastoid a single cavity. This single cavity is often known as the mastoid bowl. Also included in a CWD mastoidectomy is widening the opening of the outer ear canal (a procedure known as meatoplasty). The goal is to create a cavity in the ear that is open to air outside the ear. This is called exteriorizing ear disease, and it makes ear diseases such as cholesteatoma safer by allowing an easy passage of disease out of the body. This makes subsequent invasion into deeper structures of the ear and skull much less likely. A CWD mastoidectomy is often performed in conjunction with reconstruction or repair of the eardrum and/or the middle ear bones (ossicles).

    Other forms of CWD mastoidectomy include a modified radical or radical mastoidectomy. With a modified radical mastoidectomy a CWD mastoidectomy alone is performed. The eardrum and middle ear bones are not touched. With a radical mastoidectomy, a CWD mastoidectomy is performed and the eardrum and middle ear bones are removed permanently. A radical mastoidectomy is performed for cases of the most severe forms of cholesteatoma.

    Disadvantages of Canal Wall Down Mastoidectomy
    The CWD was the first type mastoidectomy, but it has some disadvantages. These disadvantages include: the need for frequent ear canal cleaning, water restrictions and possible hearing changes. The mastoid bowl or cavity created by a canal wall down mastoidectomy will often fill with earwax. The earwax must be removed periodically (approximately every 6 months) in order to prevent infection. The wide opening into the outer ear is visible, although it is not necessarily unsightly.

    There are times when water must be kept out of the cavity for the persons's lifetime. Water may cause infection and it may also make a patient dizzy. Sometimes a special earplug can be made to allow swimming. At times, even the earplug is not sufficient to prevent water from entering the mastoid cavity. Scuba diving is not allowed at any time after a CWD mastoidectomy.

    Another disadvantage of the CWD mastoidectomy is that the operation changes the architecture of the ear canal. Therefore, hearing may be diminished to some degree as a result in this change of architecture.

    Canal Wall Up Mastoidectomy
    The canal wall up (CWU) mastoidectomy was developed to address some of the limitations of CWD mastoidectomy. CWU surgery does not remove the bone of the ear canal or create a cavity that is exposed to outside air, as is done for CWD mastoidectomy. Rather, the mastoid disease along with trabeculated bone is removed and tissues are closed back to their normal positions. This eliminates the need for mastoid bowl cleaning, and people usually return to normal activities. The ear looks about the same after surgery as it did before surgery. A CWU mastoidectomy is often performed in conjunction with reconstruction or repair of the eardrum and/or the middle ear bones (ossicles).
    Mastoidectomy Cavity (Canal Wall Down) attachment.php?s=5122548ed937d25863ce17a3069daa59&attachmentid=1844&d=1441385786

    Disadvantages of Canal Wall Up Mastoidectomy
    One disadvantage of the CWU mastoidectomy is the higher chance of recurrent or residual cholesteatoma, relative to the CWD mastoidectomy. Residual or recurrent ear cholesteatoma after canal wall up mastoidectomy may be hidden from ear canal inspection in the office by the wall of the ear canal. For this reason, it is common to perform a second look surgery several months (typically 9 – 12 months) after the first surgery. The second look operation is performed to determine if there is residual or recurrent cholesteatoma that otherwise would go undetected by examination in the office and even by X-ray (CT). The reason for waiting several months after the first surgery is that, if residual or recurrent cholesteatoma is present, the cholesteatoma will often grow to a sufficient size that the cholesteatoma can be visualized surgically by 9 – 12 months. Operating too soon may mean that cholesteatoma will not have enough time to develop into a large enough size to be detectable. Waiting too long, however, increases the chance that a residual or recurrent cholesteatoma will damage the ear.

    At the time of the second look operation, the surgeon reopens the middle ear and mastoid and reexamines for any recurrent disease. At the same time, the middle ear bones can be rebuilt, if it is felt that hearing could be improved.

    If no cholesteatoma is found at the second look operation, no further surgery is planned. There is still a chance that chance that cholesteatoma can redevelop even if no cholesteatoma is found at the second look operation. For this reason, patients must still be followed for several years in the office to look for recurrent cholesteatoma.

    If a large cholesteatoma is found at the time of the second look operation, then a canal wall down mastoidectomy is often performed. A canal wall down mastoidectomy has a lower chance of recurrent cholesteatoma than a canal wall up mastoidectomy

    What is the Gamma Knife used for?
    The physicians of the Ohio Ear Institute , LLC use Gamma Knife radiosurgery to treat two different types of tumors: acoustic neuroma and glomus jugulare. Each of these tumors are benign, slow-growing tumors that grow in and around the deep structures of the ear. Since these tumors are slow-growing, there are three broad treatment options for each of these tumors: observation, traditional open surgery and Gamma Knife radiosurgery. There are a set of complex pros and cons that must be considered when choosing any of these options. Please consult a member of the Ohio Ear Institute , LLC to discuss these options in detail.

    What, exactly, will happen on the day of Gamma Knife Radiosurgery?
    After patients arrive at the Gamma Knife Center they are given a mild sedative (children are often completely anesthetized). Shortly after that time, a box-shaped head frame is attached to the head with four screws (two in front and two in back). The key to the gamma-knife's precision lies in this box-shaped frame. The frame serves two purposes: 1. It holds the patient's head perfectly still when radiation is given. 2. The frame acts as a reference point in determining exactly where the beams of radiation should converge.

    The four spots on the scalp where the screws enter are numbed first with injections containing an anesthetic similar to that used by dentists. Hair will not be shaved, but it may be tied back into a ponytail if it is long. The head-frame is lightweight, so patients are able to move their head around after the frame is attached to the skull.

    Once the head-frame is attached, an imaging scan (MRI or CT) is performed to locate the exact area inside the skull that needs treatment. Even though a scan may have been done before, these scans must be repeated with the head-frame in place.

    A transparent plastic box is attached to the head-frame for the imaging scans. This box has special material in it that acts as localizer when the physicians plan the necessary radiation configuration used for treatment.

    After the imaging scans are taken, it may take an hour or more for the targeting plan to be computed. During this waiting period, patients are taken to an area in the Gamma Knife Center where they can relax.
    Mastoidectomy Cavity (Canal Wall Down) attachment.php?s=5122548ed937d25863ce17a3069daa59&attachmentid=1845&d=1441385806

    When it is time for the treatment, the patient is asked to lie down in the radiation machine so that the patient's head is put into a helmet. The helmet attaches to the head-frame, which keeps the head perfectly still. This type of setup ensures that there is no head movement. The lack of head movement allows the radiation beams to converge on the target and not on the healthy tissue surrounding the target area(s).

    The helmet does not cover the face and the radiation is not felt by the patient. There is no noise during the treatment.
    The number of minutes that each radiation dose lasts is determined during the dose planning. Treatment may include multiple doses. Sometimes, more than one type of helmet and head position is used to deliver the radiation.

    The head-frame stays on the head through the entire procedure. When the frame is removed, the places on the scalp where the screws entered may be a little tender, but the pin sites typically do not scar. Some patients may have a headache or feel nauseated for a few hours after the procedure.

    Will I be sedated?
    Adult patients will be given a pill to take prior to placement of the head frame. The pill causes a sensation of relaxation, but patients are still awake. The scalp is numbed (anesthetized) with an anesthetic similar to that used by dentists.

    Young children are given a general anesthetic for the entire procedure including placement of the head frame.

    How long does the procedure take?
    Patients are asked to come to the Gamma Knife Center early in the morning. The head frame is typically placed shortly after 6 am. The actual time of radiation varies depending on the size and location of the area to be treated. Most patients go home before Noon on the day of the procedure.

    References:
    Ohio Ear Institute: Gamma Knife Radiosurgery-What to expect











    Last edited by Medical Photos; 09-04-2015 at 04:56 PM.

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