Applicability of Paediatric Kerrison's Punch in Endoscopic Transcanal Mastoidectomy-Harnessing a Fresh Perspective

The science of endoscopic ear surgery is gaining popularity and increasing momentum with reported outcomes comparable to conventional microscopic ear surgery. Endoscopic ear surgery has numerous advantages including access to visualization of occult areas of middle ear like sinus tympani. The endoscopic transcanal mastoidectomy via conventional drilling technique(Inside-out) has also established itself as a successful procedure with excellent post-operative outcomes. However, transcanal drilling is a challenging procedure as it requires extreme coordination, repeated irrigation and suction, injury to vital structures, tympanomeatal flap tear. We here propose a novel technique of doing Endoscopic transcanal mastoidectomy using upcutting and downcutting, straight and angled Paediatric Kerrison's punch to remove the attic and posterosuperior bony canal wall with substantial benefits of significant reduction in chances of injury to vital structures, no repeated suction-irrigation required, less operative time and good visualization. Paediatric Kerrison's punch is an instrument which is essentially available in the armamentarium of all ENT surgeons as it has been used since a long time in dacryocystorhinostomy surgery. In our quest for simplifying transcanal mastoidectomy, we have devised a novel utility of this same punch in the otology surgery. And in our experience, it has proven a pragmatic instrument in the otology surgeries as much as it is in the nasal surgeries.