ORL
ro
the otosclerotic tissue), may accelerate
t
ake
the evolution of the otoslerotic tissue.
h
o
to
We are often tempted to incriminate er-
d/P
roneously the operative technique for the
l
an cochlearisation of the inner ear, but we have
noticed cases in which the operated ear and
h
o
to
non-operated one, presented the same pro-
gressive cochlearization in time. This sus-
F
o
to: P
tains Professor Cinca Danila’s theory about
the inexorable evolution of otosclerosis.
In House’s procedure, the moment
when columella is put into place may be
difficult, and the rupture of the lenticular
process is possible (when one try to mobi-
lize the tube).
Another situation consists in the per-
foration of the footplate with the tip of
the polyethylene tube or with the tanta-
lum wire, creating a transplatinar hole
which may lead to a translabyrinthine fis-
tula with consecutive dry labyrinth.
The postoperative evolution and the
cicatrisation are out of any control of
cophosurgery. There are some cases in
which although surgery was very difficult,
the postoperative evolution was unex-
pectedly good. Unfortunately there were
also reverse situations in which surgery
went on nicely, with no difficulties, but the
postoperative evolution was disastrous
(complicated with granuloma of the oval
Figure 1. X-ray of the skull of an infant, side view, showing imperfect osteogenesis (also
niche, transplatinar fistula with dry laby-
known as Lobstein’s disease and brittle bone disease)
rinth, defective cicatrisation and so an).
Unfortunately, when the surgeon is eager
that prove to be hard to crack and vice-versa, There are apparently normal footplates, to perform a faultless operation and hopes
thick ones that crack easily into pieces. that at percussion maneuver change their in a favorable postoperative evolution, then
Sometimes, an abnormal fragility of color from blue to whitish-yellow. It is a sign complications and unfavorable postoperative
the footplate is present (unexplainable of otosclerotic invasion of thefootplate de- evolutions occur. This situation is hard to ac-
decalcification), that by a simple palpa- spite its normal appearance, gives signs. cept both by the patient (which is desolated)
tion may be perforated. In the cases of platinectomy, performing and the surgeon (which is frustrated).
A normal footplate consists of desmal a central or a marginal hole (safe hole), may This unpredictability concerning the in-
type tissue that never generates callus. provoke uncontrollable fracturing of the traoperative practice as well as the postop-
The otosclerotic focus is made of haver- footplate, with bone fragments balancing erative evolution makes it more an art than
sian type bone tissue. Fracturing the oto- inside the labyrinth (a very dangerous situa- a cophosurgical science.
sclerotic focus produces an increase in the tion, both in the processing of the operative We also must take into account the
development of this pathologic tissue. procedure and in the postoperative perspec- fact that we don’t know the etiology of this
The talent and flair of a cophosurgeon tive evolution). genopathy, otosclerosis or otospongiosis,
consists in the right identification of the Using a drill to perforate the footplate manifested by haversian conversion of a des-
desmal bone and avoidance of the oto- may provoke uncontrollable fracturing mal tissue.
sclerotic focus. and sliding of the bone fragments of the That’s why the surgeon must avoid,
As a matter of fact, fracturing is alea- footplate into the labyrinth, but in cer- as much as possible, failures. Especially
torily produced, according to the native tain cases, we have observed that drill- nowadays, when malpraxis moderates
thickness of the footplate, individual varia- ing in the otosclerotic focus in order to considerably the surgeons’ eagerness
tion, resistance of the otosclerotic tissue, enlarge the oval niche and to make the and directs this pathology towards hear-
and so on. footplate thinner (of course, concerning ing aid fitting. n
Bibliography
1. Cophosurgery, T. Ataman, Editura Ştiinţelor Medicale 2004, Traian 2. Chirurgia otologică, Editura Ştiinţelor Medicale.
Ataman. 3. Otologie, Traian Ataman, Editura Tehnică, Bucureşti, 2002.
Nr. 2/februarie 2009
pag. 17
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