PPT on ossciculoplasty - types- surgical technique-success

1. OSSICULOPLASTY
Dr.Shilpa M J

2. SURGICAL PRIORITIES –
CHRONIC MIDDLE EAR DISEASE
• Make ear safe
• Make ear dry
• Make it work

4. IDEAL MATERIAL
• Biologically stable (resistant to
resorption and non-reactive)
• Correct mass and stiffness
• Easy to handle
• Ideally low cost

5. AUTOGRAFT HOMOGRAFT ALLOPLASTIC
MATERIALS
Same patient Human donor tissue
Pre pared graft
Solid plastic -
polyethylene
Ossicles, cortical bone,
cartilage
Ossicles, cortical bone,
cartilage, en bloc
ossicles with TM
Solid metals – stainless
steel, gold, titanium
Incus interposition Benefit – shortening
operative time
Porous sponge like
plastic
Limitation : not
uniformly present in
diseased ear
No risk of residual
disease if harvested
correctly
proplast, plastipore
Resorption Limitation : disease
transmission
Ceramics
Implanting residual
disease
Viral, prion - CJD Aluminium oxide,
hydroyxyapatite
Recommend :
autoclaving ossicles
Recommend :
serological donor
screening,proper
ossicle preparation
Prosthesis – no
unwanted inflammatory
reaction and bio-
integrates.

7. TERMINOLOGY
PORP – Partial ossicular replacement prosthesis
TORP – Total ossicular replacement prosthesis
COLUMELLAE – Sound transmission restored with an ossicle
to TM connection
ASSEMBLIES – Ossicle to ossicle connection

13. Staged reconstruction

14. MIDDLE EAR RISK INDEX 2001
OTOLOGIC FACTOR MAXIMUM SCORE
OTORRHOEA 3
PERFORATION 1
CHOLESTEATOMA 2
OSSICULAR STATUS 4
MIDDLE EAR GRANULATION 2
PREVIOUS SURGERY 2
SMOKING 2
Ossiculoplasty Outcome Parameter Staging

15. ABSENT INCUS
CLASSIFICATION OF DEFECTS

16. MODIFICATIONS BY KARTUSH
• O Intact ossicular chain
• E Ossicular head fixation
• F Stapes fixation
Not covered by Austin – Kartush Classification
• Isolated malleus handle fracture
• Fracture of the stapes superstructure
• Partial incus erosion

17. Lower - better

28. RECENT ADVANCE
MALLEUS REPLACEMENT PROSTHESIS
• Improved results than TORP
• Reduced prosthesis displacement

30. OUTCOME FACTORS :
• Prosthesis design and surgical technique –
affect result
• Most significant – status of the middle ear
• Surgical results from ossiculoplasty tend to
deteriorate over time.

31. THANK YOU