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Stapedotomy surgery for Otosclerosis

Otosclerosis is an abnormal sponge-like bone growth often found on the footplate of the stapes. The Malleus and Incus can have slight movement, but the stapes can not move, so the sound is either severely reduced, or never reaches the inner ear. Stapedotomy is the procedure to fix this condition. The surgery is made via the external auditory canal. Step one is to delicately separate the joint between the Incus and the Stapes. Next, Malleus-Incus mobility is confirmed, and the Stapes inmobility due to the otosclerosis of the footplate, can be confirmed with gentle pressure. Notice the up and down piston movement is impossible. We need to remove the stapes superstructure. First we divide the stapes tendon, then we use a laser to reduce the thickness of the posteriror and anterior crura. The final cuts are done using a low speed microdrill with a .7mm diamond dust bur, and the remaining structure is removed with a microhook. The distance is now measured from the incus to the stapes footplate to determine prosthesis length. A fenestra, or opening, is needed through the stapes footplate. A laser is used to make a rosette patern, then the final opening is done with the microdrill. Next a vein graft is placed into position. According to the measurement taken previously, the stapes prosthesis is trimmed to size. The loop is opened to break the teflon memory... and the distal tip of the shaft is introduced over the vein into the fenestra. The loop on the opposing side is then crimped around the incus. Final positioning is carefully checked by means of a gentle bend test to make sure everything stays in place. Now the osiccular chain can transfer the sound movement all the way to the inner ear.