Antromastoidectomy

Antromastoidectomy is a surgical procedure involving the middle ear, in which the mastoid antrum and the air cells of the mastoid process of the temporal bone are opened. The primary objective of the surgery is to remove purulent and destructive infectious foci to prevent life-threatening complications.

This is is classical procedure for acute mastoiditis — a purulent inflammation of the mastoid process that typically arises as a complication of acute or chronic suppurative otitis media. The intervention aims to eradicate infection, debride affected bony structures, and ensure adequate drainage of the middle ear.

Indications and Surgical Principles

The primary and consistent indication for antromastoidectomy is acute mastoiditis. In this condition, purulent inflammation destroys the bony septa between mastoid air cells, forming a single purulent cavity (empyema). The procedure is also indicated when other otogenic complications develop.

In this case, surgical access is via a retroauricular (postauricular) approach. During the surgery, the cortical layer of the mastoid process is removed, the mastoid antrum is opened, and all bone cells affected by pus and granulation tissue are excised individually until healthy bone is reached. Anatomical structures such as walls of the facial nerve canal, semicircular canals, and sigmoid sinus must be preserved by all means.

Clinical Significance

Antromastoidectomy is a life-saving procedure, as it prevents the spread of infection from the temporal bone into the cranial cavity (e.g., meningitis, brain abscess) or even systemic sepsis. The diagnosis of mastoiditis requiring surgical intervention is based on clinical manifestations (pain, postauricular swelling, protrusion of the auricle), otoscopic findings (pulsatile otorrhea, bulging of the posterosuperior wall of the external auditory canal, and a prominent tympanic membrane), and is confirmed by computed tomography (CT) of the temporal bones.

When performed in a timely manner, the surgery leads to complete recovery and generally does not affect hearing acuity, as the ossicular chain remains intact.

Postoperative management includes antibiotic therapy and regular dressing changes.