A case of Dr. Robert Vincent
In the field of otology, revision surgeries are critical interventions that can make a big difference in patients' quality of life. On this occasion in the surgical training app SurgSchool, we will explore a complex congenital stapedotomy revision surgery performed by the Dr. Robert Vincent, renowned otologic surgeon at the Causse Ear Clinic in Beziers, France. This specific procedure, known as “congenital stapedotomy revision: malleus displacement,” was performed on a patient previously operated on unsuccessfully by another surgeon.
Case Background
The patient in question had undergone a stapedotomy that resulted in immediate failure. During the evaluation, Dr. Vincent identified several problems, including malleus fixation and a prosthesis that had not been properly placed.
Surgical procedure
- Flap Elevation and Initial Evaluation: Dr. Vincent began by elevating the tympanic flap to expose the prosthesis and middle ear ossicles. He noted that the prosthesis was still attached to the incus, but there was no interposition and the stapes plate appeared to be quite thick.
- Diagnosis of Hammer Fixation: The main complication identified was epithymanic ankylosis of the malleus, which means that the malleus was fixed and could not move freely. This condition prevented the correct transmission of sound through the ossicles of the middle ear.
- Removal of the Prosthesis and Relocation of the Hammer: The next step was the removal of the existing prosthesis. Despite the extraction, the hammer remained stationary. Therefore, Dr. Vincent proceeded to dissect the hammer handle and perform a repositioning technique to position the hammer posteriorly.
- Vein Graft Preparation: Before proceeding, a vein graft taken from the dorsal aspect of the patient's hand was prepared. This graft would be crucial for the success of the intervention, providing an adequate base for the new prosthesis.
- Window Enlargement: The window was insufficient. Using a 0.7 mm diamond bur, Dr. Vincent carefully enlarged the window, sparing critical structures such as the patent stapedial artery, which could cause severe complications if damaged.
- Venous Graft and TORP Prosthesis Placement: With the window properly prepared, the vein graft was placed and then the TORP (Total Ossicular Replacement Prosthesis), designed by Dr. Vincent, was inserted. This hydroxyapatite and Teflon prosthesis is biocompatible and does not require cartilage interposition, which reduces the risk of rejection and improves eardrum tolerance.
- Reevaluation and Final Adjustments: After placing the prosthesis, precise measurements were made to ensure optimal length and position. The graft and prosthesis were adjusted to guarantee correct sound transmission.
En SurgSchoolWe are proud to share such detailed and educational procedures that highlight the importance of continuing education and excellence in otologic surgery. This surgery by Dr. Robert Vincent is exclusive to the app SurgSchool.
