In the revived era of stapes mobilization, the first group of approaches following Rosen's1-3 leadership involved indirect force applications transmitted to the ankylosed area to liberate the fixed stapes from its pathologic attachments and remobilize it. Thus, force was applied either to the incus, to the incudostapedial articulation, to the neck, or to the crura, utilizing various shaped picks and blunt instruments. In these early attempts, many successful results were obtained. This indirect type of operation is still in use throughout the world, with a yield of approximately 30% successful mobilizations. In the other 70% of cases, the indirect approach usually resulted in either the disruption of the incudostapedial joint or crural fracture, so that the force application never quite reached the crucial ankylosed area and remobilization was not achieved.
As experience in this approach accumulated, it became obvious that it was not desirable to sacrifice the ossicular chain
GOODHILL V. Prosthetic Articulations in Stapes Surgery. Arch Otolaryngol. 1961;73(3):273–289. doi:10.1001/archotol.1961.00740020281005
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