A case of Dr. Nirmal Patel
In this video, uploaded in Spanish and English to the SurgSchool surgery app, we explore an advanced technique used in otolaryngology for the treatment of malleus fixation, a condition that can cause conductive hearing loss. The procedure, performed by the Dr Nirmal Patel, involves the release of the anterior fixation of the malleus by underwater milling, preserving the ossicular chain and significantly improving the patient's hearing.
What is anterior fixation of the malleus?
Mallet fixation is a condition that occurs when the middle ear bone adheres to surrounding structures, preventing its normal mobility. This can result in conductive hearing loss, where sound waves are not transmitted correctly to the inner ear.
In many cases, anterior fixation of the malleus is caused by a thickening of the ligament that connects the malleus to the anterior wall of the ear canal. If left untreated, this condition can worsen, making surgical treatment necessary to restore mobility and hearing function.
Surgical technique: Underwater milling
El Dr. Patel uses an innovative technique that employs underwater milling, a less invasive and more precise procedure compared to traditional techniques. This approach involves the use of a high-speed diamond bur and water to minimize the heat generated during milling, reducing the risk of damage to surrounding tissues and improving the safety of the procedure.
The procedure begins with a standard incision to access the middle ear. Underwater drilling is then used to release the fixed malleus, using a series of different sized drills to release the bony fixation without compromising the ossicular chain. During the process, special care is taken to avoid damaging the chorda tympani, a delicate structure that could cause sensorineural hearing loss if affected.
Postoperative results and recovery
Once the malleus has been released, the surgeon replaces the incision with a small amount of perichondrium graft to close the perforation, if necessary. The results are remarkably positive. At six months postoperatively, a significant improvement in the patient's hearing was observed, confirming the effectiveness of the surgery.
The use of underwater milling has shown not only an excellent success rate, but also a faster and less painful recovery for patients, making this approach increasingly popular among otolaryngologists around the world.
Why is it relevant for otolaryngologists?
This procedure offers an effective solution for patients with malleus fixation, a problem that, if left untreated, can result in permanent hearing loss. In addition, the use of the underwater drilling technique allows for surgery to be performed with greater precision and a lower risk of complications.
