Stapedectomy
Stapedectomy, is a surgery for reconstruction of ossicular chain and labyrinthine windows in patient with stapedial ankylosis. Otosclerosis, is the most common cause of stapedial ankylosis (or stapedial fixation). Its cause is unknown and resulting conductive hearing loss.
In recent years partial removal of stapes (partial stapedectomy) become increasingly popular compared with total removal of the stapes (complete stapedectomy or total stapedectomy). Different ENT surgeons use a variety of terms for partial stapedectomy such as stapedotomy, stapes replacement, teflon piston procedure, small fenestration technique, NiTiBOND Stapes Prosthesis etc.
Important Preoperative Diagnostic Procedures For Stapedectomy
 |
| Important Preoperative Diagnostic Procedures For Stapedectomy |
The differantial diagnosis includes, middle ear effusion, ankylosis of the head of malleus, subluxation of the ossicular chain or fracture of the ossicles due to trauma, adhesions, congenital anomalies of the ossiular cahin or windows, eustachian tube disorders.
Audiological investigations which are, pure tone odiogram, speech odiograms, impedance audiometry, stapedial reflex tests, tuning work tests must be done.
Radiological investigation includes high resolution CT scan and Schueller's graphy to acces the congenital inner ear anomalies and to demonstrate the cochlear otosclerosis.
Indications For Stapedectomy Operation
 |
| Indications For Stapedectomy Operation |
General
indications for
stapedectomy are as
follows:
- Sapedial fixation due to typical otosclerosis
- Fixation of annuler ligament of the oval window
- Certain congenital anomalies
- Tympanosclerosis in which removal of the stapes is indicated (usually a staged operation)
Contrandications For Stapedectomy Operation
 |
| Contrandications For Stapedectomy Operation |
General
contraindications for
stapedectomy are as
follows:
- Rapid loss of inner iar function or very poor inner ear function
- Otosclerosis combined with Meniere's Disesase
- Hemophilia
- Marked perceptive deafness after a previous stapedial operation
- Acute infectious disease of middle or external ear
- A perforated ear drum (tympanic mebrane should be closed first and a stapedectomy delayed for six months)
Stapedectomy Technique
Stapedectomy Animation
 |
| Stapedectomy Animation Stapedectomy Operation - Total Stapedectomy - Partial Stapedectomy - Stapedotomy - Stapedial Ankylosis - Preoperative Diagnostic Procedures For Stapedectomy - Indications For Stapedectomy Operation - Contrandications For Stapedectomy Operation - Stapedectomy Technique - Stapedectomy by using Titanium Piston - Stapedectomy Risks & Complications - Postoperative Patient Care For Stapedectomy |
Stapedectomy may be carried out either under local anesthesia with sedation or general anesthesia.
Partial Stapedectomy
- Endaural incision (with or without rosen incision) is done.
- The middle ear opened.
- The suprastructure (both crura and head of the stapes) of the fixed stapes identified.
- Inclustapedial joint and the stapedial tendon is cut.
- The stapes suprastructure removed from oval window.
- A hole or openeing is created in the posterior part of the footplate.
- Stapedial prosthesis (or teflon piston) is placed between the long rocess of the incus and the footplate.
- The vestibule is covered and middle ear closed.
Alternative technique (stapedotomy) include openeing of the footplate is only slightly larger than the piston of the teflon prosthesis.
Total Stapedectomy
In this technique, entire fixed stapes removed from the oval window. The open vestibule is covered by connective tissue or fascia.
Stapedectomy Risks & Complications
 |
| Stapedectomy Risks & Complications |
Possible complications & risks of stapectomy
include:
- Injury to the incudo-stapedial joint
- Damage to the facial nerve
- Injury to jugular bulb with profuse bleeding, if jugular bulb is high and floor of the middle ear dehiscent.
- Perforation of the tympanic membrane
- Middle ear infection.
Postoperative Patient Care For Stapedectomy
 |
| Postoperative Patient Care For Stapedectomy |
After surgery, if you have a head dressing, remove it on the second post operative day. A cotton ball in the ear opening will be found when the dressing is removed. Please remove the cotton plug on the second day after surgery. You may see further packing in your ear canal. Leave this until your post-op visit.
Do not get water in the operated ear. Use petroleum jelly (Vaseline) coated cotton to plug the ear for bathing until the doctor tells you the ear is ready for water exposure. No nose blowing for a minimum of two (2) weeks.
Open mouth to sneeze for two (2) weeks. Do not stop a sneeze by squeezing your nose. No lifting, straining, bending, or stooping for two (2) weeks after surgery (the effort to get out of the recliner may cause the inner ear to leak). When getting out of bed, roll so that you can use your hands to push up rather than stomach muscles to pull up when getting out of a lying-down position.
Resuming normal activities:
Some patients are dizzy for a while after surgery. Resume driving and return to work when your dizziness and/or lightheadedness have improved sufficiently and if your job activity fits within lifting restrictions, listed below. Dizziness after surgery usually improves more rapidly the more active you are. Avoid ladders, step stools, and unprotected heights until you can move quickly in any direction without dizziness or lightheadedness. The more quickly you work back into normal routines, the more quickly you will feel better and energy will return.
Between two (2) and six (6) weeks after surgery, do not lift over 10 pounds (about the weight of a phone book) unless otherwise instructed. From 6 weeks to 3 months postop, limit lifting to less than 30 pounds. Gentle, regular walking is encouraged right away, as dizziness allows. Fast walking or light non-impact cardiovascular exercise may resume at 2 weeks after surgery.
Avoid running until 6 weeks postop. Avoid aiplane flights for 3 weeks post-op. From 3 weeks to 3 months postop, decongest your nose with Afrin nasal spray 30 minutes prior to take off and 30 minutes prior to landing if flying.
Source links:
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
Comments
Post a Comment