Materials and Methods
This study was based on a review of the tertiary center charts of
childhood-aged patients who, between 2010 and 2020, underwent
mastoidectomy surgery. All cases were performed by senior, experienced
surgeons at tertiary healthcare campus (A.G. or M.C.V.). From these
medical records, we collected data regarding demographics (age and
gender), diagnose, physical examinations, treatments, complications, and
VAS scores for acute pain obtained during the postoperative stays.
We analysed the data according to two (2) groups: children who received
a mastoid pressure dressing for 24-hours postoperatively and children
who did not receive any pressure dressing (where their wounds were only
covered). Eligible patients for the study were children under age 18 who
underwent mastoidectomy surgery for inflammatory etiology at our
institution between 2010 and 2019. Exclusion criteria included: (1)
bleeding disorders; (2) mastoid pressure dressing removed less than
24-hours postoperatively; (3) endaural approach mastoidectomy (4)
mastoidectomy with non-inflammatory indications, such as cochlear
implantation; and (5) lack of follow-up.
Complications were classified as major or minor, as described in
previous studies16,17. Minor complications were
defined as adverse events that were managed by medical measures,
conservative treatment, or minor surgical procedures. Examples are
surgical site infection (SSI), dehiscence, and seroma aspiration. Major
complications included adverse events that required major surgical
procedures; intracranial complications, such as meningitis; or a
permanent disability, such as persistent facial paralysis.
All operations were performed with the patient under hypotensive general
anesthesia and all ears were locally infiltrated, post aurally and
inside the meatus with 1:200,000 adrenaline. Standardized operative
techniques were used for all cases. Hemostasis was achieved using
bipolar diathermy at a setting of 12 W. Wound closure in the non-mastoid
pressure dressing (NMPD) group was achieved with interrupted
subcutaneous sutures, interrupted or continuous skin sutures, and 1.5 cm
Steri-Strip® applied along the line of the incision,
covered by Steripad (Figure 1 ), while in the mastoid pressure
dressing (MPD) group subcutaneous sutures were followed with tissue
adhesives for skin closure and Steri-Strip®application.
The MPD is composed of a circumferential head bandage with several gauze
pads (6 x 6 cm) and cotton wool over the pinna and the mastoid. A ribbon
gauze is tied over the eyebrow to keep the bandage in place
(Figure 2 ). The surgical incision was evaluated at discharge
and at the first postoperative appointment, two to four weeks after
surgery. For all patients, routine prophylactic, postoperative
antibiotic treatment was administered systemically for seven days and
locally, via eardrops, for two weeks.