Disadvantages. If the surgeon be not experienced, it is not so safe a method as that of first exposing the antrum.
Stacke’s operation. After exposure of the field of operation, as in the Küster-Bergmann operation, the fibrous portion of the auditory canal is separated posteriorly from the bony portion.
Fig. 227. Stacke’s Operation.
Any granulations, together with the malleus and incus, are removed from the tympanic cavity (see [p. 353]). Under a good illumination, using a head-lamp if necessary, the surgeon passes a seeker along the auditory canal, its point being made to project into the attic in order to define its limits and that of the aditus. The innermost portion of the upper posterior wall of the auditory canal, that is, the outer wall of the attic, is now removed piecemeal by means of a small gouge (Fig. 227). By working backwards the aditus is approached, the bone being removed carefully in small fragments. The seeker is inserted repeatedly into the entrance of the aditus so as to rest on the external semicircular canal, in order that the position of the latter and the underlying facial nerve may be kept constantly in mind. More bone above and external to this point is removed in small fragments, until at length the upper and innermost portion of the antral wall is removed and its cavity thus exposed. The cavity is gradually enlarged by removing still more bone in a backward and outward direction, until finally it resembles that left after the complete operation. Stacke originally devised this method in those cases in which he considered that the disease was limited to the ossicles, the walls of the attic, aditus, and innermost portion of the antrum. It was, indeed, merely a more radical method of performing ossiculectomy.
Advantages. Although this operation has practically been abandoned as a method of performing ossiculectomy, yet under the following conditions it may be adopted during the performance of the complete operation:—
1. If the mastoid be very sclerosed and if the antrum cannot be exposed, although the bone has been removed to a depth corresponding to its usual position.
2. If there be difficulty in exposing the antrum in the performance of the radical operation owing to the lateral sinus projecting far forwards and the middle intracranial fossa overlapping it externally.
Disadvantages. The chief disadvantage is that it is more difficult and tedious to begin the operation within the depth of the wound, and if the meatus is very deep and narrow it may be almost impossible to carry out.
Preservation of the ossicles and tympanic membrane after performing the complete mastoid operation.