The sandwich cartilage shoe technique for ossicular reconstruction in a case of an unsecure stapes footplate

Abstract

This article describes a new surgical method for total ossicular reconstruction in a case of a broken stapes footplate. We developed the technique of the "cartilage shoe sandwich," which consists of two surgical steps. First, the closure of the oval window is achieved by a cartilage shoe without a central perforation. During this surgical intervention, the prearrangement of a secure placement of a total ossicular replacement prosthesis is provided by a second cartilage with a central hole that is plugged with silicone. In a staged procedure, the silicone plug is removed and the ossicular reconstruction can be performed. The audiological results of the first patients show a stable inner ear function with an air-conduction gain of 9 dB. The technique described herein has proven to be safe and reliable in total ossicular reconstruction in the event of an unsecure stapes footplate.

TORP Ossiculoplasty Outcomes with and without a Stapes Footplate Prosthesis

“…Other studies have shown similar encouraging results using other means for imparting stability at the level of the footplate with a TORP prosthesis, including construction of a cartilage footplate shoe 7 and a floating cartilage sandwich shoe. 8 A recent study examined outcomes of TORP ossiculoplasty using a similar footplate prosthesis and found similar short-term outcomes to ours for both patient groups. 9 Other outcomes studies of total ossicular replacement prostheses (for TORP performed without FPP) have shown similar postoperative air-bone gaps as well.…”

“…In the case of a total ossicular replacement prosthesis (TORP), the 2 points of fixation are the prosthesis head to the tympanic membrane and malleus (or tympanoplasty graft) and the prosthesis shaft to the stapes footplate. Several methods of ossicular prosthesis stabilization have been described, including cartilage grafting techniques 7,8 and at least one similarly designed implant. 9 The titanium stapes footplate prosthesis (FPP; Grace Medical, Memphis, Tennessee) was designed to create a stable connection between a TORP and the stapes footplate.…”

Footplate Reconstruction

“…Bremke et al (10) described the use of cartilage to cover unstable footplates before placing a TORP in a similar manner to ours. They include a second piece of cartilage (''shoe sandwich'') with a central perforation to place there the shaft of the prosthesis in a second stage surgery 6 months later.…”

Comprehensive Treatment of Middle Ear Cholesteatoma

“…Освен това тези случаи са комплицирани и от възможността за проникване на инфекция към вътрешното ухо. Тук е задължителна реконструкцията на плочката на стремето с хрущял или с фасция (9). Когато няма възможност за реконструкция на слуховата верига, извършваме реконструкция само на тъпанчевата мембрана, т.е.…”