Special situations in stapedotomy: facial nerve coursing over stapes footplate
by Kailash Sant T

Jaypee’s Video Atlas of Operative Otorhinolaryngology AND Head & Neck Surgery

by Vicky S Khattar, Bachi T Hathiram
About Video

This video shows a dehiscent facial nerve that courses over the otosclerotic stapes footplate is a challenging situation, which usually presents to the surgeon on table for the first time, since one does not routinely perform imaging for otosclerosis, unless one anticipates an ossicular deformity, or when there is a history of previous surgery. In this video, the technique of overcoming such a situation has been demonstrated by performing a ‘promontory drill hole’ adjacent to the inferior part of the annulus. Initially, the promontory mucosa is scored, followed by drilling a small trough with a 1 mm burr, directed slightly towards the annular ligament. One may need to intermittently retract the facial nerve, but this should not exceed more than 5 seconds at a time with 20 seconds of interval between two successive pushes. The final fenestrum is about 0.4 mm in diameter. The other principles of stapes surgery such as sealing the site with lobular fat, crimping of the piston, etc. remain the same.

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