Management of incus dislocation by physiological repositioning of the incus

Abstract

Data have been collected prospectively from 11 patients (12 affected ears) with traumatic disruption of the ossicular chain. Isolated dislocation of the incus is the most common finding in our cases, but two had stapes arch features and two had fractures of the tympanic bone. The most common cause of the injuries was a road traffic accident. We describe a technique designed to reposition the incus in its physiological position. This involves a combination of a tympanotomy and a posterior approach to the attic region. The results in five patients (six ears) treated in this way are presented.

Conductive hearing loss after head trauma: review of ossicular pathology, management and outcomes

“…Others feel that the incudomalleolar joint is relatively easy to re-establish because the articular surfaces are complementary. 5 In our experience, a partial ossicular interposition, using the malleus head between the manubrium and long process of the incus, was used with success. Incudostapedial joint dislocation presents a different challenge, due to its small area of contact.…”

“…Excellent results were obtained in all studies for most patients, even many years after injury, and this can be attributed to the success of the various methods of repair, as well as to the fact that, in contrast to chronic ear surgery, the middle ear in such cases is lined by healthy mucosa and has normal eustachian tube function. 5 There have been reports of concomitant middle-ear pathology encountered during ossicular chain repair; in particular, one must ensure that the stapes footplate is mobile before fashioning a repair. 1,6 None of our patients had computed tomographic (CT) evaluation of the ossicular chain pre-operatively, although non-contrasted CT is known to demonstrate ossicular chain disruption or fractures.…”

The Influence of Incudostapedial Joint Separation on the Middle Ear Transfer Function

“…It is mainly because the dislocated incus after trauma is not in physiological position. The surfaces of the ISJ are usually separated and need to be approximated and supported [12,13,14]. In temporary ISJ separation during middle ear surgery the position of the ossicles is intact thus it does not require any reconstruction.…”

Surgical Management and Hearing Outcome of Traumatic Ossicular Injuries

“…To treat incudostapedial discontinuity in a conservative way, Cremin [3] described a method with a polythene tube to reconnect the incus and stapes. A variant of this method is an incudostapedial joint splint made from a silicone grommet, as proposed by Mills et al [20] . These techniques can now be replaced by ossicular bridging with hydroxyapatite bone cement.…”