Stapes surgery
made easy
Dr Tushar Kanti ghosh
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SMS
STAPES MADE SIMPLE
Dr Tushar Kanti Ghosh
M.S(KOL)M.R.C.S(GLASGO),FELLOW IN FESS
Founder Director - Ghosh ENT Foundation
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01
History &
Examination
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PTA
● Reveals AB Gap
● AB gap greater in the lower frequencies
● Carhart’s notch – dip in the BC graph
TYMPANOMETRY
● Early stage – Type “A”
● As disease progresses- type “As” curve( stapes fixation)
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Do everything
before
everything
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Without support
With good support
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STAPEDOTOMY SIMPLIFIED
IN 4 STEPS My Technique
1) Footplate fenestration • Endaural Endomeatal approach
2) Measuring the length of the • Tympano-meatal flap raised
• Posterior canal wall drilled for
piston and placing it optimum and adequate exposure
3) Posterior crurotomy
4) Anterior crurotomy
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ADVANTAGES
foot plate is supported by footplate chances of slipping and
stapes, stapedial tendon and complications like a floating footplate
incudo stapedial joint can be minimized
Prevention of facial nerve injuries preservation the stapedial tendon
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REVERSE STAPEDOTOMY with skeeter
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STAPEDOTOMY (half reverse)
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POSTERIOR CRUROTOMY
INSTRUMENT
LASER SKEETER DRILL
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REVERSE STAPEDOTOMY with LASER
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STAPEDOTOMY by HALF REVERSE
STEP BY STEP
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STAPEDIAL TENDON & POST CRUS
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FENESTRATION OF FOOT PLATE
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FENESTRATION OF FOOT PLATE
INSTRUMENT
LASER PERFORATOR
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MEASURING THE PISTON LENGTH
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PISTON INSERTION
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PISTON CRIMPING
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ANTERIOR CRUROTOMY
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STAPES SUPRA STRUCTURE
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STAPES SUPRA STRUCTURE
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STAPES SUPRA STRUCTURE
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STAPES SUPRA STRUCTURE
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STAPES SUPRA STRUCTURE
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STAPEDOTOMY REVERSE STAPEDOTOMY
Stapedial tendon cut Fenestration
Division of post Crus Prosthesis insertion and crimping
Supra structure fractured Division of post Crus
Fenestration Division of ant crus
Prosthesis insertion and crimping Supra structure removed
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REVISION SURGERY
Persistent AB Gap > 25 dB Reassess surgical video
Persistent Intractable vertigo Preop CT
Facial nerve complication Intra op Assessment
requiring intervention Incus erosion
Dislocated prosthesis
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CONCLUSION
Minimum age for surgery 1 5 Fenestration technique
GA vs LA 2 6 Length of the prosthesis
Approach 3 7 Type of the prosthesis
Type of stapedotomy 4 8 Management of complications
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CREDITS: This presentation template was created by
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Thanks…
Do you have any questions?
[email protected]
+91 9830196537
WWW.GHOSHENTFOUNDATION.COM
CREDITS: This presentation template was created by
Slidesgo, including icons by Flaticon and infographics &
images by Freepik
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