This method of operation is well known and has been performed for some years, especially by Jansen of Berlin, and in America.
The only indication for this modification of the complete mastoid operation is disease involving the antrum and mastoid process so extensively as to require complete removal of the posterior wall of the auditory canal, without there being any coexisting bone disease of the walls of the attic or of the ossicles.
As the complete mastoid operation is only performed for some condition due to chronic middle-ear suppuration, it is difficult to imagine that the ossicles and attic region could remain unaffected when the extent of the disease necessitates the complete operation.
In my opinion, if it be necessary to remove the ‘bridge’ it is also necessary to remove the outer wall of the attic and with this the malleus and incus. If, on the other hand, there be no bone disease of the attic region or of the ossicles, Schwartze’s operation, or some modification of it, should be sufficient. The majority of aurists agree that, excepting in those cases in which the continuance of the suppuration is due to an empyema of the antral cavity, the ossicles are almost invariably carious to a greater or lesser extent in chronic middle-ear suppuration. This view is supported by Grunert’s researches (Archiv für Ohrenheilkunde, Band 40), who found that the ossicles were only normal in five cases in a series of 113 cases in which the complete operation had been performed.
Although removal of the ‘bridge’ may eradicate the disease within the mastoid process and antrum, yet, if the ossicles are left, post-suppurative adhesions will almost certainly afterwards bind them down and so cause a greater deafness than if they had been removed originally. Still, a few isolated cases have been reported in which hearing to the extent of 20 feet or more has been obtained as the result of this operation. The same results, however, frequently occur after the performance of the complete operation with removal of the malleus and incus. Until we have a large and consecutive series, recording the results of this particular operation in detail, together with information regarding the duration of the symptoms, the previous treatment, and the condition of the ear before operation, it is impossible to judge the value of this method.
THE FORMATION OF POST-MEATAL SKIN FLAPS
This is done for two reasons: firstly, to prevent stenosis of the auditory canal; and secondly, to aid the growth of the epithelium over the wound surface, so that the latter will heal as rapidly as possible.
| Fig. 228. Post-meatal Skin Flaps (Author’s method). Bistoury incising the posterior fibrous portion of the auditory canal. The dotted line shows the line of incision. A is the Y-shaped flap afterwards sutured to the skin behind the auricle. | Fig. 229. Post-meatal Skin Flaps (Author’s method). Flaps cut: A, Y-shaped flap sutured to the skin; b, Superior flap; c, Inferior flap. |
