Critical evaluation of the "jigsaw" assembly for ossiculoplasty

A modification of an ossiculoplasty technique, in which a hole is drilled through an ossicular or cortical bone graft so that it can encircle the malleus handle, has been evaluated during a 4-year period. During this time, 26 operations have been carried out. The 1-year hearing results obtained have been compared with those for conventional operations in ears with the same ossicular defect by creating matched pairs whose preoperative air-bone gaps differed by no more than 5 dB. There is no difference between the hearing results for the two groups. Revision operations have been carried out in five cases. In two of these the cause of failure was iatrogenic cholesteatoma. This probably occurred because the technique demands the separation of the malleus handle from the tympanic membrane. This can be easily achieved except at the lower end, where the attachment is much firmer. The incidence of cholesteatoma in the study group is higher than that found in the author's patients who have undergone conventional ossiculoplasty operations. The "jigsaw" technique has no advantage over conventional ossiculoplasty techniques and, in view of the risk of cholesteatoma formation, cannot be recommended.