Approaches to Middle ear and Mastoid surgery
Endomeatal (Transcanal or Transmeatal) Approach:
- Rosen incision: A posterior tympanomeatal flap is raised to enter into the middle ear. The flap includes skin over the medial two-thirds of the bony external auditory canal.
- Exploratory tympanotomy.
- Underlay or Inlay myringoplasty(small posterior perforations and medium-sized perforations ).
- Ossiculoplasty (Ossicular reconstruction).
- Stapedotomy and Stapedectomy (Otosclerosis surgeries).
Endaural Approach (Lempert or Heerman incision):
- Incision kept: Lempert -I(Posterior meatal wall in bony-cartilaginous junction), Lempert -II_Curvilinear incision between the tragus and helical crus).
- Commonly used in infants and young children.
- Accessibility of epitympanum and posterosuperior part of mesotympanum.
- Temporalis fascia graft or tragal cartilage or perichondrium can be easily obtained.
- Excision of osteomas and exostoses of the ear canal
- Central tympanic membrane perforation
- Atticoantrotomy for Attic cholesteatomas
- Wilde’s incision: A postauricular incision is marked 5 mm posterior to the auricular crease in a curvilinear fashion, extending from the mastoid tip to the temporal line.
- Cortical mastoidectomy
- Modified radical and radical mastoidectomy
- Tympanoplasty (when perforation extends anterior to handle of malleus)
- Decompression of the facial nerve
- Endolymphatic sac surgery