Traumatic malleus and incus dislocation: assembly and relocation with Silastic bands
En the app SurgSchool, we are committed to high-quality surgical training, providing our users with access to complex and advanced clinical cases. Here we present a tympanoplasty after head trauma performed by the Dr. Vincent, leading otological surgeon at Causse Ear Clinic, in Béziers (France). The procedure described below is a right tympanoplasty in a patient who suffered severe head trauma.
Case Description
The patient had a complete dislocation of the ossicular chain, mainly with the malleus displaced. The intervention began with the exploration of the middle ear cavity, identifying a significant fracture in the wall of the upper and upper posterior bone canal.
Step by Step Procedure
- Exhibition and Initial Evaluation:
- Fracture Identification: A large fracture was observed in the wall of the superior and posterior bone canal. The tympanic membrane was atrophic and it was decided to reinforce it.
- Hammer Condition: The hammer was completely fixed, but an attempt was made to dissect it to evaluate its possible use.
- Ossicular Chain Repair:
- Replacement Cartilage: Cartilage was taken to reconstruct the fractured areas.
- Anvil Dislocation: The anvil was hypermobile and disconnected from the stapes.
- Hammer Relocation:
- Hammer Mobilization: Through delicate techniques, an attempt was made to relocate the hammer so that it could be used in the reconstruction.
- Measurement and Adjustment: The distance from the malleus to the stapes plate was measured for precise placement of the TORP (Total Ossicular Replacement Prosthesis).
- Prosthesis Placement:
- Graft Preparation: A perichondrium and cartilage graft was used to reinforce the tympanic membrane and provide a stable base for the prosthesis.
- Implementation of the TORP: The prosthesis was placed between the malleus and the stapes plate. It was crucial to adjust the length of the prosthesis to avoid improper fixations that could compromise mobility.
- Verification and Completion:
- Final Positioning: The position of the prosthesis was verified and it was ensured that all components were mobile.
- Flap Replacement: The tissue flaps were repositioned and a merocel was placed in the ear canal, which will be removed on the fifth postoperative day.
Final Thoughts
This surgery highlights the skill and precision necessary to manage complex cases of head trauma affecting the middle ear. The use of advanced bone reconstruction techniques and the placement of ossicular prostheses are essential to restore hearing function and prevent long-term complications.
El Dr. Robert Vincent In this case, he demonstrates his skill in otological surgery, delicately handling the structures of the middle ear to achieve a successful reconstruction. For those interested in honing their skills in this field, the platform SurgSchool offers detailed resources and case studies covering various advanced surgical techniques.
