Transcript stapedectomy

STAPEDECTOMY
Kelsey Carter
ANATOMY
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Ear
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Stapes
Tympanic membrane
Ossicles
Incus
concha
PATHOPHYSIOLOGY
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Stapedectomy is the surgical intervention of
choice for patients with otosclerosis.
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Otosclerosis:
 Bony over growth of the stapes
 Foot plate becomes fixed in the oval window
preventing normal sound vibrations from
entering the ear.
 Hereditary, mostly in women.
SURGICAL INTERVENTION
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Positioning:
Supine.
 Patient’s arm on the operative side may be tucked
while other arm may be extended on an arm board.
A donut may be placed under head.
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Instruments:
Ear instrument set
 Sterile components of ear drill
 Universal ear speculum holder
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SURGICAL INTERVENTION
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Supplies:
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Basic pack
Basin set
Gloves
Head and neck drapes
Fenestrated adhesive plastic drape
Microscope drape
Micro wipe
Suture accodring to surgeon’s preference
Dressing materials according to surgeon’s preference
Pharmaceuticals according to surgeon’s preference
Bulb syringe
Prostheses
Blade #15
SURGICAL INTERVENTION
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Draping:
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Patient may be draped with 3-4 sterile towels placed
around the operative ear.
A sterile adhesive drape may be placed
Head is draped with a disposable sheet.
Two folded towels may be placed at the patient’s
neck.
A split or drape sheet is placed to cover the patient’s
body.
SURGICAL INTERVENTION
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Prep:
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Cleanse the operative ear, extending form the
hairline to the shoulder and well beyond the midline
of the face.
Prep well behind the ear on the operative side.
Caution should be taken to avoid the pooling of prep
solution in or around the eyes and ears.
Surgeon may request that 1” of hair be
clipped/shaved behind the ear and that the remaining
hair be taped out of the operative field.
Prepped site should be dried well in order for the
adhesive ear drape to stick.
Cotton may be placed inside the operative ear.
PROCEDURAL STEPS
1)
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A graft may be harvested from the ear, hand, or a portion of the abdomen
prior to the start of the procedure. The graft will be used to cover the oval
window. A fat, perichondrium, vein, or fascia graft may be utilized.
External ear canal is injected with local anesthetic.
The operative microscope is used to visualize the middle ear.
The external ear canal is irrigated and suctioned with a 7-Fr Frazier suction
for further visualization
Surgeon inserts an ear speculum, starting with a small speculum and
advancing to a larger one.
Surgeon may elect to suction with a 5-Fr Frazier or microscution tip to
remove any fluid from the ear
The tympanomeatal flap is created by using a roller knife, sickle knife, or
flap knife.
The tympanic membrane is elevated and the posterior bony ledge removed
using a house knife, duckbill elevators, or a drum elevator. Once the
tympanic membrane is elevated. The surgeon is able to visualize the
ossicular chain.
If surgeon is unable to visualize the ossicles due to a bony ledge , a drill may
be used to remove enough bone for proper visualization.
Surgeon may elect to measure the distance from the incus to the stapes
footplate or may wait until after the stapes is removed.
11) Incostapedial joint is disarticulated using a house or guilford-wright joint knife.
Laser may be used to perform this step of the procedure. The stapedial tendon is
severed with bellucci scissors
12)
A fine rosen needle and microcupped forceps are utilized to fracture the stapes
superstructure.
13)
Surgeon may ensure hemostasis by using tiny sponges that have been soaked in
epinephrine.
14)
Surgeon creates an opening in the footplate with a laser, drill, or sharp footplate
pick.
15)
Surgeon inspects the oval window and the graft is placed with an alligator
forceps.
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The prosthesis is introduced into the middle ear on alligator forceps to be
positioned so it rests against the oval graft.
17)
Wire is positioned over the incus by using a Hough hoe, picks, or footplate hooks.
Once surgeon is satisfied with the position, the wire is crimped onto the long
process of the incus.
18)
At this point surgeon may test patients hearing by whispering to patient
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Moistened gelatin squares may be placed around the site of the prosthesis for
stability.
20)
Tympanomeatal flap is replaced using a duckbill elevator, rosen needle, or drum
elevator
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The external ear canal may be packed with moistened gelatin sponge, antibiotic
gel, or antibiotic ointment
22)
Cotton is placed in the concha of the ear and the graft site is dressed.
23)
A glasscock or mastoid dressing may be utilized.
PROGNOSIS
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Patient is expected to return to normal activities
within 2 weeks.
COMPLICATIONS
Dizziness
 Tinnitus
 Taste disturbances
 Loss of hearing
 Eardrum perforation
 Temporary weakness of the facial muscles
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ALTERNATIVE PROCEDURE
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Stapedotomy
Small opening is created in the fixed stapes footplate
with a small drill or a laser.
 Allows for transmission of sound waves or placement
of the prosthesis.
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