ORL
ro
otologie
Unpredictable factors
in the surgery of otosclerosis
T. Ataman M.D, Ph.D
1
, Daniela Montescu M.D.
2
1. professor of Otorhinolaryngology
2. Paper made at the Institute of Phono-audiology
and E.N.T. Functional Surgery ˝Prof. Dr.Dorin Hociota˝,
Bucharest
Abstract
The authors present a lot of un predic­ cause they could lead to some fai­
table factors in surgery of otosclerosis. l u r e s .
These factors must b e t a k e n into Keywords: middle ear, otosclerosis, sur­
account and their cause known be­ gery of stapes, accidents, complications
Rezumat
ing a mentor (Gelfoam), while large rup- disjunctor or the thick needle, it may be
tures might require even a myringoplasty overlooked an associated Goodhill syn-
of necessity (with temporal fascia or vein). drome, even if the handle of the malleus
Autorii prezintă o serie de factori im­ Experienced cophosurgeons are aware of all seems to be mobile ( false mobility due
ponderabili în chirurgia otosclerozei.
these and try to avoid this accident. to the elasticity of the handle).
Aceşti factori trebuie luaţi în seamă
In other cases, a vascular fragility is Severing of the stapedial tendon by
şi cunoscuţi, putând fi cauza unor eşe­
present, leading to small haematomas diverse procedures may generate an ac-
curi.
even at the slightest touch with the sur- cidental dislocation of the stapes.
Cuvinte-cheie: ureche medie, oto scle­
roză, chirurgia scăriţei, accidente, com­
gical instruments. This situation is like a Severing of the stapedial arch and the
plicaţii
premonition for what could happen at the incudostapedial joint dislocation may
footplate’s level towards the labyrinth. lead to the rupture of the lenticular pro-
Anyway, the flap atrophy and vascular cess, rupture of the descendent apophy-
Any surgeon, owing high self-esteem, fragility are warning signals concerning sis of the incus, fracture of the stapedial
strives to perform faultlessly the elected the likely postoperative evolution. arch with the intralabyrinthine sliding
surgical technique, according to given lo- Abundant bleeding during decollation of the footplate, or with the fracture of
cal situation, available instruments and so of the tympanomeatal flap is another the footplate in several pieces.
on. The accomplishment of all operative premonition factor for possible further In platinolysis procedures, in Fowler’s
steps with accuracy and art, gives him a complications, such as intracavotym- procedure for instance, during anterior
great satisfaction, similar to a painter or panic haematoma. crurotomy, the anterior pole of the foot-
a sculptor facing his finished masterpiece. High emergence of chorda tympani plate may be accidentally fractured and
This is in theory. nerve is a major risk factor of its rupture dur- a labyrinthine fistula occurs.
Unfortunately, the practice is a little ing its decollation and a factor that hinders Footplate fragments, in platinolysis pro-
different. Not always the calculus made the normal proceeding of the next operating cedures, may be mobile towards the laby-
by a surgeon in his mental planning and sequences at the level of the oval window. rinth. In these procedures no perilymph is
sequencing of the operation matches re- A simple elongation of chorda tympani is allowed to appear (sign of on accidentally
ality. Each step of an operation implies enough to provoke postoperative aguesia in created fistula during surgery).
a lot of unpredictable factors that may about 10-15% of the operated cases. The footplate may have different
alter both the intervention and the re- Resection of the postero-superior angle thicknesses and resistances and these
sult. Starting with the incision, it may be of the scutum may be complicated with may not be estimated by microscopy.
straight, clean or fringed with efractions the rupture of the tympanic membrane or Generally, it is admitted that a footplate
in the medial portion or even with acci- with fracture trajectories towards danger- of a bluish color is a footplate non-in-
dental rupture of tympanic membrane, ous zones. Also, this resection may favor vaded by the otoslerotic focus, but the
due to an atrophy, or fragility of the tym- the accidental dislocation of incus, lead- status of the intralabyrinthine part of
panomeatal flap in the given area. Gen- ing thus to an Escat syndrome, difficult to the footplate is not detectable usually (it
erally, there is a risk of tympanomeatal correct. is only deduced).
flap rupture at the level of the posterior In exposing the surgical field, and Not always the fracture pattern of the foot-
quadrant and in front of the round win- during the indirect mobilization test by plate is in good accordance with that expect-
dow. Small ruptures may be corrected us- palpation of the malleus handle with the ed by the surgeon, there are thin footplates
pag. 16
Nr. 2/februarie 2009
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