[Posterior crus stapedectomy: an obsolete method in otosclerosis surgery?].

BACKGROUND

Stapedectomy and stapedotomy with interposition of prostheses are the methods of choice for surgical treatment of otosclerosis. For the present study we resumed and reevaluated the posterior crus stapedectomy, a method based on the principal of renouncing a prosthesis by cutting the posterior crus of the stapes close to the footplate and the anterior crus close to the stapes head.

METHODS

The posterior crus is temporarily transposed with the incudostapedial joint remaining intact. After performance of platinectomy and sealing of the oval window with fascia it is repositioned onto the center of the window.

RESULTS

19 of 20 ears operated on applying this technique showed good results (closure of air bone gap) after a mean follow up of 24.6 months. One patient showed persistence of air bone gap of 32.5 dB. Revision surgery revealed that the posterior crus had migrated to the posterior rim of the oval window. No inner ear affection, perilymph fistula or sensorineural hearing loss were observed.

CONCLUSIONS

The major advantage of this technique is the avoidance of incus necrosis and foreign body reactions related to the material of the prosthesis. Disadvantages are technical plus the longer duration of the procedure.