THE PROBLEM of avascular or hypovascular degeneration of the long process of the incus is a well-recognized entity.1,2 With the direct attack upon otosclerosis, we are becoming aware of avascular necrosis secondary to surgical trauma within the middle ear.3-5 Necrosis has been suspected secondary to head trauma.1,2 Those who have done a significant number of "vein graft" stapedectomies have had the occasion to observe necrosis of the tip of the incus as one of the late complications. We are now well aware of the problem and are determined to minimize the chance of its occurrence. It is significant then to relate precautions we take to this end.
The normal blood supply of the incus is supplied by the ossicular branch of the anterior tympanic artery. It usually enters the incus on the lateral side of the body. There is also a blood supply from the posterior branch
WEBB BM, FIELDS RL, MCFARLAND JJ, MOFFET DB. Incus Precautions in Middle Ear Surgery. Arch Otolaryngol. 1966;84(3):313–315. doi:10.1001/archotol.1966.00760030315009