DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Otosclerosis, right ear.
POSTOPERATIVE DIAGNOSIS:
Otosclerosis, right ear.
PROCEDURES PERFORMED:
1. Right ear stapedotomy.
2. Harvest of right ear lobe fat graft for oval window seal.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old Hispanic male who has had left ear stapedotomy and has a right ear conductive hearing loss. The risks and benefits have been discussed and are signed in the office chart. The patient was interviewed preoperatively in the holding area prior to sedatives. All questions were answered, and the consent was signed.
DESCRIPTION OF PROCEDURE: The patient was placed in supine position under general anesthesia by endotracheal tube. The right ear was prepped with Betadine and draped sterilely. The meatus and posterior canal were injected with 1% Xylocaine with 1:50,000 epinephrine. The fat graft was harvested from the ear lobe through a separate incision. This was inspected for skin and trimmed into strips and placed in balanced salt. The incision was closed with three sutures of 4-0 nylon.
The posterior canal incision was made, and the tympanomeatal flap was elevated down. The middle ear space was entered. The posterior overhang of bone was curetted giving excellent visualization of the facial nerve, stapedial tendon, anterior and posterior crus of the stapes. As on the opposite side, the patient had a deep narrow niche for the oval window. The palpation of the malleus and incus showed good mobility. Palpation of the stapes showed it was fixed. It also seemed to have some attachment to the promontory on the inferior edge, superior, possibly due to old inflammatory disease. The argon laser was used to severe the stapedial tendon, then to weaken the anterior crus, and to severe the posterior crus. The #5 instrument was used after the joint was separated to take the superstructure medially. When this was removed, the oval window was carefully suctioned, and palpation showed the footplate to be stable.
The argon laser was used in a rosette pattern on a setting of 1.5 to cauterize the footplate. This was then drilled with a skeeter drill, and the anterior hook was used to clean any fragments from the end. The suction was used away from the opening, and at no point in the procedure was the oval window or vestibule evacuated of fluid. The measuring stick was used, and similar to the other side, it appeared that 4.25 mm prosthesis would be the best. This was placed into position with the shepherd’s crook over the incus. This was positioned into the distal end of the incus and crimped into position, and the wire was slightly bent under it to position the prosthesis further from the facial nerve and to give it a more vertical orientation in the oval window.
Fat was placed in the oval window niche surrounding the stapes prosthesis. A piece of fat was placed on the incus overlying the crimped prosthesis. There was a small rent in the drum at the annulus exactly posteriorly, so a small piece of fat was placed under this and completely underlaid the area, which was in good approximation as well. The drum was placed against the posterior wall and held in position with strips. Balanced salt solution and cotton was used for the bolstering of the ear canal. The patient tolerated the procedure well. Estimated blood loss was less than 5 mL, and there were no intraoperative complications.
