There are many occasions when the long process of the incus is not available for attachment of the prosthesis in stapedectomy, such as with fenestrated ears or with atrophy, fracture, or notching of the long process, or if the long process has been destroyed by previous middle ear disease or is congenitally fused or deformed. The usual method of attaching a malleus prosthesis is from underneath the tympanic membrane, which presents certain technical difficulties.
In a new external approach, the prosthesis is placed through the drum into the oval window. Holes are made in front of and behind the malleus, and the polytef wire prosthesis is put through the tympanic membrane and positioned in the oval window by alternately working outside the tympanic membrane and in the middle ear. The wire is crimped onto the malleus from outside the ear drum.
Scheer AA, Amjad AH. A New Method of Incus Bypass in Stapedectomy. Arch Otolaryngol. 1974;100(4):322–323. doi:10.1001/archotol.1974.00780040332019
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