closedmet.ppt

完壁术式——Fisch 技术Closed MET (Ugo Fisch Technique)  北京大学第三医院耳鼻咽喉科 马芙蓉 furongma@126.com Closed Mastoido-Epitympanectomy with Tympanoplasty(Closed MET) Surgery for Otitis Media and Cholesteatoma Tympanum Tympanoplasty (Myringoplasty+Ossicle Reconstruction) Mastoid Simple Mastoid Operation Tympanum +Mastoid Tympanoplasty Open cavity: Ossicle reconstruction +Canal wall down Closed cavity : Ossicle reconstruction +Canal wall up Subtotal Petrosectomy with Preservation of Otic Capsule Surgical Highlights General anesthesia Retroauricular skin incision Meatal skin flap Canalplasty Middle ear inspection Mastoidectomy Epitympanectomy Posterior tympanotomy Complete removal of cholesteatoma matrix Tympanoplasty Surgical Technique The closed mastoido-epitympanectomy with tympanoplasty is a tympanomastoidectomy in which particular emphasis is applied to the work in the attic. A closed MET includes mastoidectomy, and epitympanoplasty, posterior tympanotomy and tympanoplasty. Middle ear inspection Division of the incudostapedial joint Mastoidectomy Exposure of mastoid plane Identification of antrum Correct bone removal Danger of incorrect bone removal Surgical site after mastoidectomy The broken lines show the position of the antrum. Epitympanectomy Exposure of the attic Identification of tympanic facial nerve Identification of tympanic facial nerve Only on rare occasions, does an extremely large cholesteatoma prevent adequate identification of the facial nerve along the lateral semicircular canal. In such a situation, it is best to follow the mastoid facial nerve from the stylomastoid foramen into the area where the anatomy has been distorted by the lesion. EMG monitoring of facial function is essential in such a situation. Management of semicircular canal fistula Management of semicircular canal fistula Management of semicircular canal fistula Manag