Atlas of Ossiculoplasty Madhuri Mehta
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1Atlas of OSSICULOPLASTY2
3Atlas of OSSICULOPLASTY
Author Madhuri Mehta MBBS MS Director of ENT Department Medical Superintendent NC Jindal Institute of Medical Sciences Hisar, Haryana, India Forewords Mario Sanna KP Morwani
4
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Atlas of Ossiculoplasty
First Edition: 2017
9789386150585
Printed at
5Dedications
In our Hindu culture, Guru is considered supreme, 
because through him we get to envision God. 
This book is dedicated to my Guru Dr KP Morwani, 
who guided me not only through the nuisances of otorhinolaryngology 
but also showed me the ways of life.
I would also like to dedicate this book to my son Navroz, 
my greatest source of inspiration, who has given a true meaning to my life6
7Foreword
Professor Mario Sanna MD
Director, Gruppo Otologico
Center for Advanced Otology
Hearing Implantology and Skull Base Surgeries
Piacenza, Rome, Italy
At the outset, I congratulate Madhuri for coming out with a well written book on an important subject in otology: ossiculoplasty. Very few other fields in surgery have undergone the kind of advancement in the past century as seen in otology. From simple tympanic membrane repairs to cochlear implants, the subject has journeyed many a mile in a very short time. Many giants in otology have contributed to the development and refinements of the techniques in otological surgeries that have brought back hearing and smiles to many a patient and surgeon across the world. I am happy to see that the baton of progress in otology is being carried forward by many young and passionate otologists of today like Madhuri Mehta, in India and around the world.
I have known Madhuri for many years now, the first encounter being her visit to the Gruppo Otologico as an observer. She exhibited signs of her brilliance with the drill and microscope by winning the best dissector award in a course here. Since then she has been in touch with our group having visited us on other occasions. Madhuri has not only proven to be a good surgeon but also a good teacher and writer. This is her second book and I am pleased to see that she continues to maintain the zeal and enthusiasm for the subject that is reflected in her constant endeavour to improve herself and contribute.
I am sure this book will be a landmark in the specialty in the times to come and I wish the book and its author all success.8
9Foreword
Dr KP Morwani DORL MS
President Skull Base Society of India Year 2016
Hod Ent Department, Fortis Hospital, Vashi, Navi Mumbai
Hod Ent Department, Nanavati Super Speciality Hospital Mumbai
Consultant Hinduja Healthcare Khar, Mumbai, Maharashtra, India
Dr Madhuri Mehta first participated in our Temporal Bone Dissection course about 12 years ago. During the course, I was informed by my junior colleagues that she was dissecting exceptionally well, and her dissecting skills, as well as precision and neatness in her dissection, were much ahead of the rest of dissectors. She was judged as “Best Dissector” of that batch, and I am proud to say that she is, in fact, one of the best dissectors I have come across in more than 100 Temporal Bone Dissection courses organized by my institute so far.
She has been a very keen and enthusiastic student, and I had the opportunity to conduct few workshops at her institute at Hisar. Besides, I have visited her center multiple times to help her refine her surgical techniques, and grow up into an accomplished and dexterous surgeon.
Dr Madhuri is indeed one of the best students I have ever had, and a very quick learner. I can proudly say that she is one of the fastest growing and busiest female ENT surgeons of India.
Now, gradually, she herself is emerging as a teacher, passing on her share of knowledge and skills to the fraternity of ENT surgeons.
In this monogram titled “Atlas of Ossiculoplasty”, she has gone very systematically, and presented various techniques of ossiculoplasty, using various materials, applicable in different clinical situations. The operative photographs, and the art work, showing various defects and various clinical situations, are absolutely outstanding.
To me, this is one of the best monograms on ossiculoplasty I have ever come across. I wish her all the best.10
11Preface
Any surgical procedure, specifically a finer one like ossiculoplasty is the result of a detailed analysis, logical planning, and perfect execution.
Ossiculoplasty is a surgery in which the result is directly proportional to the detailed preplanning and mathematical approach to a given situation. Many factors play an important role in the final outcome of hearing for the patient, such as the cause and extent of the disease, the material and technique used for that particular situation, and the situations favoring or disfavoring the surgical intervention.
The first aim of surgery is the complete eradication of disease, at the same time we must try to bring the postoperative hearing level closest to the normal hearing. Ossiculoplasty is one of the most difficult and the finest procedures with a special thrill in each case because at the end, our extra efforts are going to be rewarded in the form of better hearing for the patients.
The manual skills required for the aerobics that we perform in middle ear for ossicular chain reconstruction can be acquired by repeated temporal bone dissections, and can be improved upon by regularly following up the results of surgeries already performed.
For me, it has been a feeling of sheer joy and a childlike enthusiasm to go through this practice of evolving with every case of ear disease, aiming for optimal results in all cases. When we don’t compromise for anything but the best, we usually achieve it.
The aim of this book is to compile and explain every possible situation in ossicular chain disease and then with a pure logical and methodical approach, decide every possible technique available for that single situation with optimum results and surgical outcome in mind.
The book has been prepared in great details showing meticulously executed surgical steps through pictures and hand drawn diagrams.
The tag line of the book remains:
The planning and preparation of the surgical procedure remains the first important step. The second important step is the execution of surgical skills to bring the hearing level closest to the normal hearing.
With every passing year more such cases will be added and an interactive platform will be developed through which we all can share our experiences and views.
Ossiculoplasty is a work of art and passion and can only be achieved with these three convictions in mind:
12Though the materials and techniques used for ossiculoplasty procedures are changing and improving over the years but the basic principles have remained the same. The newer designs and improvements in already existing ossicular prostheses have presented their own unique challenges to the engineers involved with the development of these products. The aim is to create and manufacture prostheses which are biocompatible and at the same time closest to the original ossicles in size, shape, weight, and functioning. Through these continued efforts and the technological developments taking place around us each day, complete restoration of hearing through the use of newer techniques and materials might someday become a reality.
Madhuri Mehta
13Acknowledgments
Knowledge has no boundaries. It transcends time, place, culture, and generations. It cannot be kept restricted. To grow, it has to spread to people around and to the future generations. It has been passed on to me by great teachers and I am trying my bit to hand it over to my ENT colleagues, with a hope that they continue the trend of teaching and passing on.
To start with, I would like to thank Dr KP Morwani, the person who is the force behind my growth and progress in ENT and specifically otology and neurotology. Dr Morwani, past president of Association of Otolaryngology of India and present president of Skull Base Society of India needs no introduction. A living encyclopedia of otology and skull base surgery, Dr Morwani is one of the best teachers of the country.
Before I met him, I was practicing ENT. Thanks to him, I now live and breathe ENT. I am a painter by nature and surgeon by profession. He taught me how to use the brush and the scalpel together passionately, creatively, and devotedly.
For the first time, I could realize the untapped energies in me, when I was given “Best Dissector” award at Temporal Bone Dissection workshop conducted by Dr Morwani in the year 2006. This was further reinforced when the “Best Dissector” award was again bestowed on me the following year by none other than Professor Mario Sanna, the renowned skull base surgeon at “Gruppo Otologico”, Piacenza, Italy.
I am privileged to be a student of Professor Mario Sanna, the world’s best known skull base surgeon. I met him first in 2006, when I watched him perform live surgery at the Lateral Skull Base Surgery workshop at Nanawati Hospital in Mumbai. That was my first encounter with skull base surgery. The following year, I was among 20 surgeons from India who went to Italy with Dr Morwani for a training under Professor Sanna, at “Gruppo Otologico”, the Centre for Otology and Lateral Skull Base at Piacenza. Before leaving for Italy, I had the opportunity to read different books authored by Professor Sanna, from which I got an insight into the intricacies of otology and lateral skull base.
The days at Gruppo Otologico proved to be a life-shaping experience for me. It gave me a new direction and broadened my vision as a surgeon. I began to see otology beyond the confines of mastoid bone. A whole new world opened up for me and it helped me shape myself as a thinking and performing surgeon. The award that I received from Dr Sanna himself gave me the impetus to explore further and work harder towards achieving perfection.
That the maestro has consented to write the foreword for this book is the best reward I could ever get.
I also wish to thank Dr SPS Yadav who was my guide during my postgraduation in ENT, Dr Anil Monga, who introduced me to otology as early as 1996, and Dr Ashutosh Pusalkar, Dr Mahadeviah A, Dr Santosh Kakkar, and Dr Mohan Kameshwaran, who have been the guiding lights in my professional life.
I would like to express my gratitude to Dr Trishna Kakad and Dr Rachana Zaveri from Mumbai for helping me in proof reading the manuscript and Dr Priyanka Chabra, the radiologist from my institute, for contributing in writing the chapter on ‘Radiological Correlation with Anatomy’.
At home I have had generous help from my institute—NC Jindal Institute of Medical Care and Research, my colleagues and staff members of the ENT ward, and operation theater at the institute, without whose assistance this work would not have been completed. I would like to mention their names because the best workers live in anonymity while we take all the credit for the work. Starting from Mr Krishan, my operation theater in charge, who is a real gem, to the invaluable workers like Neeru, Sushila, Sandeep, Santosh, Rajender, Ramesh, Seema, Sushila, Kanta, and Suresh. They all have put their best for completion of this book.
My special thanks to our childhood friend Mr Raman Mohan, a professional journalist for editing the manuscript for me.
Best things are kept for last. My son Navroz, who is the source of inspiration for all my endeavors and achievements, is my best friend and critic. My brother Gagandeep, his wife Shailly, and my sisters Nisha and Sadhna have all been my motivators.
I am indebted to my parents, especially my father, for teaching me the importance of discipline, hard work, and sincerity in life.
Lastly, I must thank M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, one of the most reputed and also one of the largest publishing house in the world. I also thank Dr Neeraj Choudhary (Senior Acquisition Editor-Corporate), and his team who were there with me at every step of the project with their untiring zeal to excel. I also thank Dr Swati Mishra and Gladden Savieo (Copy editors), Megha Kalra (Reader), Barkha Arora (Editorial co-ordinator), and Manoj Kumar (DTP operator) from his team.