Expose the tympanic cavity for thorough evacuation of the bulla
Remove as much chronically infected tympanic bulla bone as possible
Provide drainage of the tympanic cavity
Completely remove soft tissue from the osseous ear canal
The main reasons some surgeons tend to be less aggressive with lateral bulla osteotomy include:
Risk of hemorrhage particularly ventral to the bulla
Risk of facial nerve damage
Risk of inner ear damage
All the above
The use of which of the following instruments should be avoided or used with extreme care when performing a VBO?
Freer elevators
Kerrison rongeurs
Army-navy retractors
Gelpi retractors
The first aspect of lateral bulla osteotomy following total ear canal resection includes:
Complete stripping of epithelium from the osseous ear canal
Elevation of the facial nerve from the lateral face of the tympanic bulla
Ronguer the ventral aspect of the osseous ear canal
Bluntly dissect soft tissue from ventral to the bulla
Rongeuring and elevating tissue just rostral to the opening of the osseous ear canal increases the risk of injuring the:
Facial nerve
Trigeminal nerve
Maxillary artery
Retroarticular vein
Epithelial remnants are most often found in which area inside the tympanic cavity:
Ventral aspect
Caudal aspect
Dorsal medial aspect
Rostral dorsal aspect
The most common result of incomplete evacuation of the tympanic cavity is:
Chronic, intractable middle ear infcction
Partial facial nerve deficits
Acute wound infection responsive to antibiotics
Inner ear infection and chronic neurological signs
Injury to the internal carotid artery can result from:
Levering soft tissue from the ventral aspect of the bulla
Soft tissue dissection from the rostral aspect of the horizontal ear canal
Curettage of the medial aspect of the tympanic bulla
Curettage of the rostral aspect of the tympanic bulla
Which of the following statements is false about the technical aspects of the tympanic cavity evacuation?
All abnormal epithelium and debris should be excised
The ossicles should be removed since they can form a nidus of infection
Avoid curettage of the dorsal aspect since the promontory could be damaged
Aggressive removal of the ventrolateral aspect dramatically helps in exposing the tympanic cavity for evacuation of debris
Regarding the need for passive drainage after total ear canal ablation and subtotal lateral bulla osteotomy, which of the following statements is false?
A drain is placed if there is heavy contamination, poorly controlled hemostasis, or when the tympanic cavity is difficult to clean out properly.
The Penrose drain is placed with blunt dissection with a forceps and tunnelled ventrolateral to the bulla
When creating the tunnel for the drain, never force the forceps through the soft tissue
The drain exits usually at the ventral aspect of the vertical âTâ incision created for total ear canal ablation