Thieme: Tympanoplasty, Mastoidectomy, and Stapes Surgery

Contents
Part 1 Tympanoplasty
(Closed Cavity)
Chapter 1 Tympanoplasty
General Considerations ......................... 2
Definitions ..................................... 2
Aims of Tympanoplasty ....................... 2
Preoperative Care ............................. 2
Postoperative Care ............................ 3
Anesthesia ..................................... 4
Facial Nerve Monitoring ....................... 6
Instrumentation ............................... 7
Rules and Hints ................................ 7
Chapter 2 Myringoplasty,
Meatoplasty, and Canalplasty
General Considerations ......................... 8
Definitions ..................................... 8
Surgical Approaches .......................... 8
Selection of Surgical Approach ............... 11
Grafting Technique ............................ 11
Specific Surgical Techniques ................... 13
Transcanal Approach .......................... 13
Endaural Approach ............................ 15
Retroauricular Approach ...................... 17
Antrotomy ..................................... 37
Meatoplasty ................................... 39
Complications of Myringoplasty ............. 43
Results ......................................... 45
Rules and Hints ................................ 46
Chapter 3 Ossiculoplasty
General Considerations ......................... 48
Basic Situations in Ossiculoplasty ............ 48
Specific Surgical Techniques ................... 49
Basic Situation I: Malleus and Stapes Present,
Incus Missing .................................. 49
Basic Situation II: Footplate and Malleus ..... 55
Basic Situation III: Stapes Only ................ 74
Basic Situation III 1 , III 2 , III 3 :
Stapes Only in Closed Cavity ................. 75
Basic Situation III 4 , III 5 , and III 6 :
Stapes Only in Open Cavity ................... 91
Factors that Improve the Results
of Ossicular Reconstruction .................. 102
Results of Ossiculoplasty ...................... 115
Rules and Hints ................................ 124
Chapter 4 Special Applications
with Tympanoplasty
Transcanal Myringotomy
with Ventilating Tube ......................... 126
Temporary Access to the Round Window ... 129
Canalplasty for Exostosis ...................... 132
Canalplasty for Otitis Externa Obliterans .... 136
Congenital Aural Atresia ...................... 139
Rules and Hints ................................ 149
Part 2 Mastoidectomy
(Open Cavity)
Chapter 5 Mastoidectomy and
Epitympanectomy
General Considerations ......................... 152
Definitions ..................................... 152
Cholesteatoma ................................ 152
Classification of Cholesteatoma .............. 152
Surgical Treatment of Acquired
Cholesteatoma ................................ 156
Specific Surgical Techniques
for Cholesteatoma Removal .................... 160
Closed Mastoido-Epitympanotomy
with Tympanoplasty .......................... 160
Open Mastoido-Epitympanectomy
with Tympanoplasty .......................... 170
Tympanoplasty
in Open Mastoido-Epitympanectomy ....... 186
Exteriorization of Open Cavity ................ 190
aus: Fisch u. a., Tympanoplasty, Mastoidectomy, and Stapes Surgery (ISBN 9783131377029)
© 2008 Georg Thieme Verlag KG
IX

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Contents
Meatoplasty ................................... 196
Wound Closure and Packing .................. 199
Results of Surgery for Cholesteatoma ....... 200
Rules and Hints ................................ 203
Chapter 6 Special Applications of
Mastoidectomy
Reconstruction of an Open Cavity ........... 205
Cochlear Implant .............................. 207
Active Middle Ear Implants
and Bone Anchored Hearing Aids ............ 215
Results ......................................... 217
Rules and Hints ................................ 219
Part 3 Stapes Surgery
Chapter 7 Stapedotomy and
Stapedectomy
General Considerations ......................... 222
Stapedotomy versus Stapedectomy ......... 222
Specific Surgical Techniques ................... 224
Stapedotomy .................................. 224
Incus-Stapedotomy ........................... 224
Malleo-Stapedotomy ......................... 238
Stapedectomy ................................. 248
Rules and Hints ................................ 253
Chapter 8 Special Applications of
Stapes Surgery
Obliterative Otosclerosis ...................... 254
Floating Footplate ............................. 256
Narrow Oval Window Niche .................. 257
Anomalous Facial Nerve ...................... 260
Missing Stapes ................................. 262
Revision Stapes Surgery ....................... 267
Stapedotomy in Fenestrated Ears ............ 272
Stapes Surgery in Tympanosclerosis ......... 274
Alternative Procedure: Stapedectomy
with Spandrel II and Fisch Titanium Total .... 276
Connective-Tissue Graft for Repair
of the Tympanomeatal Flap ................... 277
Results of Stapes Surgery ..................... 278
Rules and Hints ................................ 288
Part 4 Imaging for Temporal Bone
Surgery
Chapter 9 Conventional and
Multiplanar High-Resolution
Computed Tomography of the
Temporal Bone
General Considerations ......................... 292
Technical Aspects of High-Resolution
Computed Tomography ........................ 293
Why High-Resolution
Computed Tomography? ....................... 299
Pneumatization ................................ 299
Anatomic Configuration
of the Temporal Bone ......................... 301
Specific Pathologic Changes
of the Temporal Bone ......................... 301
Evaluation of High-Resolution
Computed Tomography ........................ 301
Axial High-Resolution
Computed Tomography ...................... 301
Coronal High-Resolution
Computed Tomography ...................... 305
Chapter 10 Imaging for
Tympanoplasty and Mastoidectomy
Tympanoplasty (Closed Cavity: Tympano-
antrotomy and Tympanomastoidectomy) ... 308
Pneumatization ................................ 308
Condition of the Mastoid Cells ............... 308
Air in the Protympanum ...................... 308
Bone Destruction .............................. 309
Myringoplasty ................................... 311
Pneumatization ................................ 311
Ossiculoplasty .................................... 313
Preoperative Scans ............................ 313
Postoperative Scans ........................... 315
Titanium Incus ................................. 315
Titanium Total Prosthesis ..................... 317
Titanium Neomalleus with Stapedotomy ... 324
Special Applications with Tympanoplasty ... 325
Exostosis, Otitis Externa Obliterans,
and a Narrow External Auditory Canal ....... 325
Congenital Aural Atresia ...................... 330
aus: Fisch u. a., Tympanoplasty, Mastoidectomy, and Stapes Surgery (ISBN 9783131377029)
© 2008 Georg Thieme Verlag KG

Mastoidectomy (Open Cavity) ................. 332
Open Mastoido-Epitympanectomy
with Partial Obliteration (METO) ............. 332
Special Applications of Mastoidectomy ...... 342
Cochlear and Middle Ear Implants ............ 342
Chapter 11 Imaging for
Stapes Surgery
Incus-Stapedotomy
and Malleo-Stapedotomy ...................... 349
Diagnosis of Otosclerosis ..................... 349
Titanium Stapes Prosthesis ................... 354
Chapter 12 Rules and Hints
General ......................................... 368
Tympanoplasty and Mastoidectomy ......... 368
Ossiculoplasty ................................. 369
Titanium Incus ................................. 369
Titanium Total ................................. 369
Stapedotomy .................................. 370
Atretic Ear ...................................... 370
Middle Ear and Cochlear Implants ............ 370
Part 5 Appendix
Contents
Chapter 13 Microsurgical Equipment
Instruments and Prostheses ................... 372
Instruments .................................... 372
Middle Ear Prostheses ......................... 374
Drill (Motors, Handpieces, and Burrs) ........ 376
Motors ......................................... 376
Handpieces .................................... 376
Burrs ............................................ 377
Operating Room Equipment ................... 378
Microscope .................................... 378
Ocular Loop .................................... 378
Operating Table ............................... 378
Surgeon’s Chair ................................ 379
References ........................................ 379
Suggested Reading .............................. 380
Books ........................................... 380
Brochures for Surgical Courses ............... 380
Abbreviations .................................... 381
Index .............................................. 383
aus: Fisch u. a., Tympanoplasty, Mastoidectomy, and Stapes Surgery (ISBN 9783131377029)
© 2008 Georg Thieme Verlag KG
XI