鼓室成形术-锤骨置换假体

(Language: english & french). Left revision tympanoplasty with dislocated malleus head autograft. This patient has been operated 3 times over the last few years by another surgeon and there was aan immediate postoperative failure. During the last previous operation the surgeon inserted a grommet without significant improvement. Transcanal approach. Middle ear exploration revealed a really anterior malleus handle which could not be used and a malleus head autograft wich was unstable and partially dislocated. There was a mobile stapes which was slightly bent towards the promontory. There was a really small gap between the stapes superstructure and the Fallopian canal. Ossiculoplasty was made with a combined insertion of Malleus Replacement Prosthesis (MRP) and a Total Malleus Teflon piston (MRP-to-footplate assembly). The choice for the use of a Total malleus piston instead PORP or TORP was dictated by the presence of the stapes which was bent towards the promontory and the small gap between the Facial nerve and the superstructure. The grommet was not removed because of a posterior-superior retraction pocket which was reinforced with a cartilage and perichondrium graft. Dr Robert Vincent, Causse Ear Clinic, Béziers (Colombiers), France

                               
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