Surgical Instruments for Stapedectomy Surgery ( Ear Surgery ).

Ear - Otology - Surgical Instruments Course

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	A stapedectomy is performed to surgically remove the stapes after it has become fixed by a bone disease called otosclerosis. The operation opens the inner ear to the outside. It is very important to maintain sterility. The fluids of the inner ear are the same as the cerebral spinal fluid. Since this course is on instruments we will present a technique of stapedectomy using ear instruments. Many surgeons are now using micro-lasers and micro drills for removal of the stapedial footplate. The stapes is approached through the ear canal. An ear canal flap is raised using a similar technique to that used in a tympanoplasty and the middle ear is entered. The bone of the posterior superior canal is removed and care is taken not to injure the chorda tympani or taste disturbance or some tongue numbness may result. The chorda tympani may have to be sacrificed during the operation if it is obstructing the procedure and cannot be retracted. A measuring rod is now used to measure the distance between the stapedial footplate and the undersurface of the incus. The usual distance is 4.5 mm.
	The next step is to use a pick to test the fixation of the stapes. If it is found to be fixed a thin sharp gently curved pick is used to perforate the stapedial footplate. This will relieve pressure on the inner ear if the stapedial footplate becomes mobile during the operation.
	The stapes is now disarticulated from the incus using a joint knife or a Tabb Knife. A long 90 degree pick can also be used for this purpose.
	Next the stapedial tendon is cut using a pair of micro-scissors or Bellucci Scissors.
	Finally, the stapes superstructure is removed using a large pick. First slowly move the superstructure upward then quickly downward.
	The hole in the stapedial footplate is widen using a short 45 degree pick then a short 90 degree pick, followed by a longer 90 pick. A prosthesis is then placed and the oval window sealed with blood or tissue. The stapedial footplate hole can also be enlarged using a mushroom pick. This pick has a mushroom shaped end and thus can remove bone in any direction.
	Suctioning of blood from around the stapedial footplate must be done with great care. It is very easy to damage the inner ear with may result in deafness and dizziness. A #24 or #26 suction is used and the surgeon's finger is not placed over the suction hole. He should suction around the footplate opening and not over it. (Note: Two different systems are used to describe the sizes of suctions. The small numbers, French System, apply to the three Baron Suctions, the larger numbers are used for the stapes needle suctions. In the French system, the size of the tube increases as the numbers get larger. With the needle suctions, the size of the tube gets smaller as the numbers increase. In these two numbering systems, a #20 stapes needle suction is approximately the same size as a #3 French Baron Suction. )
	The prosthesis is grasped with a smooth alligator forceps. A serrated forceps may damage a prosthesis or bend a house wire wire prosthesis. The picture to the right shows a house wire prosthesis positioned between a stapes and a dime.
	Shown in the pictures to the right are smooth (far right picture ) and serrated (near right picture) alligator forceps.
	If a wire loop is used as a prosthesis, one of a variety of different crimpers are used to secure the prosthesis to the long arm of the incus. Shown in these pictures are several McGee Stapes Crimpers. The picture to the right shows a reverse action McGee crimper. Note the grove in the crimper's head for the stapes wire.

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