DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Chronic otitis with hearing loss.
POSTOPERATIVE DIAGNOSIS:
Chronic otitis with hearing loss.
PROCEDURE PERFORMED:
Right revision tympanomastoidectomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old who has undergone multiple operative procedures in the past and is referred now with a significant hearing loss in the right ear with a subtotal anterior perforation.
DESCRIPTION OF PROCEDURE: Following satisfactory oral endotracheal anesthesia, the right ear was prepped and draped in the usual fashion. Xylocaine, 1:100,000 epinephrine was instilled in the posterior aural area and 1:50,000 in the four quadrants of the ear canal. The canal was debrided of ceruminous material and squamous debris. A subtotal anterior perforation was noted. A postaural incision was made and carried down through skin and subcutaneous tissue. A C-shaped pericranial flap was made behind the previously created mastoid tip cavity. The pericranial flap was elevated. The posterior canal wall was identified. Koerner’s flap was cut and held forth with Perkins retractor.
The soft tissue was now evacuated out of the previously created mastoid cavity defect. Tegmen was identified superiorly, the sigmoid sinus posteriorly, the sinodural angle was cleared. The aditus ad antrum widely opened, the epitympanum was cleared and the ossicle heads were noted. Soft tissue was evacuated from the facial recess and irrigant flowed readily to the middle ear space. The tendon was noted and fibrocartilaginous scarring was juxtaposing the stapes.
Tympanotomy flap was elevated and now anteriorly-based superior and inferior canal wall skin flaps were created. The lateral process of the malleus was noted and the drum remnant was removed, creating a total perforation. Under high-power magnification, the soft tissue noted through the facial recess was now taken down from around the superstructure of the stapes and the stapes itself was now mobilized. Palpation of the chain revealed good mobility. The anterior canal wall skin was back elevated as a laterally-based skin flap was created and the ear canal was opened widely. The wound site was hemostased. Gelfoam was placed in the middle ear in the mastoid cavity and large areolar graft, which has been previously harvested, was cut into position.
With no evidence of cholesteatoma or granulation and good mobility of the bones noted, Gelfoam filled the middle ear space and underlay areolar graft was placed. The anteriorly-based superior and inferior canal skin flaps were returned to their anatomic position and the laterally-based skin flap on the anterior wall was returned to its anatomic position over a small rim of fascia. Gelfoam pledgets were now placed to maintain the continuity of the annular margin and Polysporin ointment was applied. The Koerner’s flap was returned to its anatomic position and the ear was packed with Polysporin. The postaural incision was closed in layers. A dry sterile compression dressing was applied. The Xomed facial nerve monitoring NIM-2 unit was removed. The patient was discharged to the recovery room in satisfactory condition.
