Stapes Surgery: How Precisely Do Different Prostheses Attach to the Long Process of the Incus with Different Instruments and Different Surgeons?

Kwok, Pingling; Fisch, Ugo; Strutz, Jürgen; May, John S.

doi:10.1097/00129492-200205000-00010

Cited by 44 publications

(36 citation statements)

References 7 publications

(4 reference statements)

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“…Crimping is the most difficult step during stapedotomy, since too tight fastening of the loop on the long process of the incus may cause reduction of the blood supply, which may lead to a risk of erosion or even necrosis of the incus process. Damage of the process of the incus has been described several times in literature and has been subject to controversy [13,26]. Excessive crimping or insufficiently tight fastening of the prosthesis both result in the same poor hearing results for the patient.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Otosclerosis with a Superelastic Nitinol Piston: First Results

Bast

Weikert

Schrom

2011

Indian J Otolaryngol Head Neck Surg

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Stapedotomy with implantation of an alloplastic prosthesis is a well-established therapy for the treatment of otosclerosis. Since the middle of 2008, a new Nitinol prosthesis with memory function and superelastic properties has been available which is expected to make fixation on the long process of the incus much easier. The advantage of this prosthesis is that heat-induced wire crimping is no longer necessary and damage to the incus caused by heat is avoided. Since May 2008, laser-assisted stapedotomy with implantation of a Nitinol prosthesis was performed in 21 patients suffering from otosclerosis. The prostheses used for all patients had a size of 4.5 mm 9 0.4 mm. The patient collective consisted of 14 women and 7 men with a mean age of 53.4 years. Pre-and postoperatively, an ENT examination was carried out followed by an audiological evaluation of the hearing result. In addition, the properties of the prosthesis (''proper fitt'', ''handling'', and ''overall rating'') were evaluated intraoperatively by means of a test protocol. The Nitinol prosthesis was implanted successfully in all 21 patients. The mean air-bone gap for the frequencies from 0.5 to 4 kHz was 9.83 dB postoperatively. Intraoperatively, the fit of the prosthesis was rated as ''good to very good'', the handling as ''good'' and the overall rating of the system was ''good to very good''. Our patient collective showed good postoperative hearing results. Due to simple intraoperative handling, especially placing the Nitinol prosthesis in position, the critical work step of crimping is no longer necessary.

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Section: Discussionmentioning

confidence: 99%

“…Especially the safe fixation of the prosthesis on the long process of the incus is one of the most important and difficult parts of the operation on the success of which a good and lasting postoperative hearing result depends [12,13].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Otosclerosis with a Superelastic Nitinol Piston: First Results

Bast

Weikert

Schrom

2011

Indian J Otolaryngol Head Neck Surg

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“…No or minimal residual air-bone gap after the surgery is standard in experienced hands. Surgical technique has known a slow process of refinement also partly depending on the surgeon's preference (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Stapedectomy mostly migrated to stapedotomy, and today, stapes footplate fenestration techniques are frequently made with the help of a micro drill or laser.…”

mentioning

confidence: 99%

First Experience with a New Stapes Clip Piston in Stapedotomy

Grolman

Tange

2005

Otology &Amp; Neurotology

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The use of a newly designed titanium-clip stapes piston prosthesis with a diameter of 0.4 mm gives good results in cases of stapedotomy for otosclerosis. The titanium-clip design is a new development in the evolution of stapes piston prostheses. Surgical introduction, placement, and fixation are not always easy, depending on the anatomy of the middle ear and the thickness of the fixation area on the long process of the incus.

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“…If we look on the anatomic properties of LPI to find influencing factors for the crimping results, we have to look on the crimping technique itself as well (15). Using the McGee or the straight alligator forceps, the crimping occurs at the ventrolateral and dorsomedial surface because the instruments enter the tympanic cavity approximately parallel to the external auditory canal.…”

Section: Discussionmentioning

confidence: 99%

Anatomic Parameters of the Long Process of Incus for Stapes Surgery

Tóth¹,

Moser²,

Roesch³

et al. 2013

Otology &Amp; Neurotology

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Our anatomic study revealed wide variations of diameters and shape of the LPI. Best possible crimping of stapes prosthesis depends not only on the shape and diameters of the LPI but also on the vertical surface of the LPI as well. To prevent incus necrosis due to compression of the feeding blood vessels, the maximum contact surface of the loop of stapes prosthesis should be about 1.9 mm in length.

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Stapes Surgery: How Precisely Do Different Prostheses Attach to the Long Process of the Incus with Different Instruments and Different Surgeons?

Abstract: The geometry of the loop affects the final length of the piston in the vestibule and its angle to the long process of the incus.

Cited by 44 publications

References 7 publications

Treatment of Otosclerosis with a Superelastic Nitinol Piston: First Results

Treatment of Otosclerosis with a Superelastic Nitinol Piston: First Results

First Experience with a New Stapes Clip Piston in Stapedotomy

Anatomic Parameters of the Long Process of Incus for Stapes Surgery

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