Surgical Complexity and Intraoperative Obstacles in Mastoidectomy: A Retrospective Study at JRRMCH, Sylhet

Background:
Mastoidectomy is a complex otologic procedure with difficult
anatomical navigation through the temporal bone. Despite
technological advancements, intraoperative difficulties are frequent and
may significantly affect surgical outcomes. It is important to understand
the predictors and types of intraoperative problems for surgical planning
and optimization of patient safety, particularly in low-resource settings.
Objective:
This study aimed to examine the relationship between surgical
complexity, intraoperative complications, and patient or procedural
variables in mastoidectomy, providing evidence for surgical planning
and risk stratification.
Methods:
This is a retrospective observational study conducted in Jalalabad
Ragib-Rabeya Medical College Hospital (JRRMCH), Sylhet, on 100
mastoidectomy cases operated upon from January 2022 to December
2024. Patient demographics, surgical indications, comorbidity,
mastoidectomy type, intraoperative complications, and postoperative
outcomes were analyzed. Surgical complexity was graded based on
intraoperative findings. Data analysis was performed using SPSS version
27, and significance was considered at p<0.05.
Results:
Intraoperative challenges were faced by 40% of patients. While age,
sex, and comorbidities were not significantly related to the occurrence
of challenges (p>0.05), surgical technique was. CWD procedures were
more strongly linked to challenges (50%) compared to cortical
mastoidectomy (30%) (p=0.002). Bleeding (50%), poor anatomical
visualization (62.5%), facial nerve dehiscence (25%), and dura
exposure (20%) were the intraoperative challenges, all of which were
statistically significant (p<0.001). Cortical mastoidectomy, however,
was more frequently associated with uncomplicated procedures.
Conclusion:
Mastoidectomy type significantly affected intraoperative complexity, with
CWD procedures posing more risk for complications. Preoperative
identification of high-risk cases and tailored surgical planning are required
to minimize intraoperative challenges and optimize outcomes. These
findings underscore the need for improved risk stratification and operative
preparedness, especially in settings with limited surgical resources.