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Stapes surgery: how precisely do different prostheses attach to the long process of the incus with different
Pingling Kwok1, Ugo Fisch, Jürgen Strutz
1Ear, Nose, and Throat Department, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany. pingling.kwok@klinik.uni-regensburg.de
Hypothesis:
The goal of this study was to compare the attachment of stapes prostheses with differently shaped loops to the long process of the incus.
Background:
In stapes surgery, the attachment of the prosthesis to the long process of the incus plays an important role concerning the gain in hearing and the development of late complications such as incus erosion and necrosis. Band-shaped and spiral loops have been developed to achieve a broad, firm attachment to the long process of the incus. During stapes surgery, the view at the prosthesis is restricted, making it impossible to evaluate the effects of the differently shaped loops.
Methods:
Gold, steel/Teflon, platinum/Teflon, and two different titanium stapes prostheses were inserted in 30 specially prepared temporal bones by three experienced surgeons using the Fisch technique with the McGee and straight alligator forceps for the crimping of the loops. Photographs were taken with 0- and 70-degree rod lens telescopes at defined views.
Results:
In all prostheses, a sufficiently firm attachment to the long process of the incus was achieved. The attachment of band-shaped loops proved to be better with the straight alligator forceps. The band-shaped loops showed a better contact with the incus than did the wire loops. However, the broad spiral-shaped loops led to a loss of the perpendicular axis of the piston to the long incus process.
Conclusion:
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.