Summary It is surgical repair of the ossicular chain to restore the advantage of the conduction mechanism or middle ear transformer mechanism in tympanoplasty. The surgical repair includes to reconstruct the diseased or dislocated or fixed osscicular chain. The material for this surgery may be with the available healthy osscicles or auto grafts or allogenic grafts or synthetic material. The operation is Total Ossicular Replacement Prosthesis (TORP). The MFA 4mm is used for this operation.
Types of Surgery ⒜ Partial Ossicular Replacement Prosthesis(PORP) & Replacement Incus sculpturered : Mobile stapes and mobile malleus, but absent incus or Mobile stapes and fixed malleus, but absent incus ⓑ Total Ossicular Replacement Prosthesis(TORP) : positioned on the stapes footplate covered with pressed tragal perichondrium, when the malleus is not present ⓒ Bone cement : Incus necrosis and mobile stapes and mobile malleus ⓓ stapes prosthesis : Absent stapes superstructure, but mobile footplate, incus, and malleus ⓔ Standard stapedectomy or stapedotomy : Fixed footplate and mobile malleus and inccus
type of material(prosthesis) - Titanium incus - Bridge prosthesis - Autograft or Homograft ossicles - Cortical bone - Teeth - Cartilage
placement of material(prosthesis) - the prosthesis be under slight tension and at a favourable angle. - The prosthesis should fit perfectly without tension before placement of the cartilage. - Before placing the prosthesis, the middle ear is partially filled with a middle ear packing material. - Bone cement caanot be used on the footplate. Instead, a cartilage punch is used to create a cartilage shoe.
Indications - Trauma - Erosion by chronic otitis media / cholesteatoma (most common) - Eroded incudostapedial joint (most common) - Eorded for absent incus - Partially or fully eroded stapes - Malleus head ankylosis(idiopathic) - Ossicular tympanosclerosis - Scar bands due to inflammatory middle ear disease
Complications - Tear of the annular ligament with a perilymphatic fistula - Severe or total sensorineural hearing loss