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Hammer and Gouge Mastoidectomy

Hammer and Gouge Mastoidectomy

These two surgical guides are intended for the many surgeons in the Developing World who do not have access to modern mastoid surgery equipment such functioning mastoid drills, or are regularly faced with power cuts and therefore may be compelled to proceed with a mastoidectomy using a hammer and gouge, and possibly only a headlight and operating loupes. The text and illustrations are very closely based on the description of mastoid surgery: A Treatise on the Surgical Technique of Otorhinolaryngology (1939) by Georges Portmann. The text has been modified to incorporate modern otological principles.

Mastoid surgery can only be safely performed when the surgeon has an intimate knowledge of temporal bone anatomy. It is imperative that surgeons practice temporal bone dissections as described in this IFOS educational website. Surgeons are also referred to a detailed Temporal bone dissection manual, and the YouTube demonstration of simulated modern mastoid surgery below.

Temporal Bone Dissection Guide: YouTube

  1. Introduction
  2. Initial drilling steps
  3. Saucerizing the mastoid cavity
  4. Exposing antrum
  5. Exposing middle fossa dura
  6. Exposing dura at posterior end of temporal line in poorly pneumatised mastoid
  7. Exposing sinodural angle and sigmoid sinus
  8. Skeletonising superior dura entirely
  9. Removing remaining post canal wall cells
  10. Exenterating mastoid tip
  11. Exposing attic
  12. Blue-lining posterior semicircular canal
  13. Blue-lining lateral semicircular canal
  14. Exposing facial nerve and chorda
  15. Removing bone between chorda and facial nerve (posterior tympanotomy)
  16. Cochleostomy as for cochlear implant
  17. Exposing posterior fossa dura and endolymphatic sac
  18. Opening lateral and posterior semicircular canals
  19. Blue-lining superior semicircular canal
  20. Lowering posterior canal wall (radical mastoidectomy)