Osteoplastic approach in chronic otitis media by means of a microsurgical reciprocating saw.

We have devised a reciprocating saw for microsurgery, which performs 100 oscillations per second. The amplitude of the oscillations is adjustable within the range of 3-3 mm, by pressing a pedal. The width of the saw cuts is 0.2-0.3 mm. In the osteoplastic approach the superior and posterior segment of the ear canal wall is temporarily removed. Starting from a mastoidectomy 4 cuts are performed: cut 1 from the superior anterior angle of the mastoidectomy in a horizontal direction parallel to the dural plate through the whole thickness of the lateral epitympanic wall. Cut 2 from the ear canal above the short process of the malleus in a superior direction so as to meet cut 1. Cuts 3 and 4 start from the facial recess, one from the inside of the ear canal, the other from the mastoid cavity, both meeting in a groove along the facial ridge. This exposes all middle ear spaces as in a radical mastoidectomy. After elimination of disease and reconstruction of ossicles the canal firmly into its bed, needing no further fixation. Healing of the re-implanted canal segment presents no problem.