By Dr. José Carlos Casqueiro
In our last video uploaded to the surgical training app SurgSchool, we present a detailed review of diode laser stapedectomy performed by the Dr. Casqueiro. This surgery is particularly relevant for otolaryngologists and otology surgeons due to the complexity and precision it requires.
Clinical case
The patient, a 64-year-old woman, had previously undergone surgery twice on both ears. At the consultation, she had significant conductive hearing loss in one of her ears. A CT scan revealed that the prosthesis was displaced from the oval window, which led to the need for further surgery.
Surgery Details
Dr. Casqueiro begins by explaining the importance of infiltration in different areas to minimize the risk of facial paralysis and ensure adequate exposure of the ear canal. He highlights the additional difficulty represented by a very vertical canal, which forces him to infiltrate from the bottom to obtain better maneuverability during surgery.
Surgical procedure
During the intervention, Dr. Casqueiro makes a 360-degree incision in the ear canal. He uses an elevator to ensure the incision stays in the bone, minimizing the risk of tearing the tympanic membrane, which is more fragile in patients who have had previous surgeries.
The procedure is complicated due to the presence of adhesions and the narrowness of the canal. The infiltration has generated small bubbles in the membrane, which Dr. Casqueiro must handle carefully to avoid perforations. A cholesteatoma, possibly left by previous surgeries, is identified and accurately removed.
Complications and Solutions
Surgery reveals a displaced prosthesis and an eroded long branch of the incus, confirming the initial suspicions based on the CT scan. These conditions have contributed to the patient's hearing loss. Dr. Casqueiro emphasizes the importance of avoiding excessive traction that can further damage the eardrum or prosthesis.
Using a laser, Dr. Casqueiro removes additional adhesions and performs an atticotomy to improve visibility and access to the platen and facial. This procedure is crucial to ensure that the prosthesis is placed correctly and that the surgery is the last the patient needs.
