Stapedectomy by Dr. Robert Vincent
Discover in your App SurgSchool this surgery performed by Dr. Robert Vincent, with the title Primary otosclerosis surgery "From A to Z."
Stapedectomy is a crucial surgical intervention used to address otosclerosis and restore hearing in patients with conductive hearing loss. Throughout the video of this surgery, we will explore its essential steps and their relevance in the treatment of middle ear disorders.
Patient Assessment and Preparation for Surgery:
Before performing the stapedectomy, Dr. Vincent performs a thorough evaluation of the patient. In the case presented, it is a forty-one-year-old man with bilateral mixed hearing loss, more severe in the right ear. The degree of hearing loss is determined using a gap test, with forty dBA in the right ear and twenty dBA in the left ear.
Surgical Approach and Technique Used:
Dr. Vincent begins the procedure with a transcanal approach and uses a vein graft obtained from the dorsal aspect of the patient's hand. He makes an incision with a round knife, followed by elevation of the flap until he reaches the tympanic ring. During surgery, he emphasizes the importance of clear exposure of the facial nerve and the parietal process of the stapes tendon.
Resection of the Bone Margin and Protection of the Chorda Tympani:
A resection of the bony margin is performed to improve exposure of the facial nerve, and careful protection of the chorda tympani is performed to preserve the patient's gustatory function. Dr. Vincent emphasizes the importance of this preservation and discusses the possible complications associated with manipulation of the nerve during surgery.
Stapedectomy Procedure and Prosthesis Placement:
Stapedectomy is performed to create a fenestration in the labyrinth, and the length of the prosthesis is determined using a special measuring rod. The Teflon prosthesis is cut to size and carefully inserted into the correct position, followed by crimping the loop around the anvil.
Results and Postoperative Care:
Dr. Vincent checks the mobility of the ossicular chain and the integrity of the stapedectomy before concluding the surgery. A vein graft is placed to seal the stapedectomy and a bend test of the prosthesis is performed to ensure proper placement. The video concludes with a discussion of postoperative care and short- and long-term patient follow-up.
