Incus as interposition graft between handle of malleus and stapes
by Mehta Madhuri

Atlas of Ossiculoplasty

by Madhuri Mehta
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This case is the left ear of the patient findings tympanosclerosis anterior quadrant of tympanic membrane. Canaloplasty done in posterior and inferior quadrant for exposure of tympanic membrane and retraction pocket in all quadrants. Tympanic membrane is retracted in posterior quadrant, with cholesteatoma in posterior superior quadrant and tympanosclerosis in anterior quadrant. Handle of malleus and stapes head reflecting through the retracted drum. Anteriorly reflected posterior canal wall skin can be visualized. Inside-out mastoidectomy performed to reach the outer most extent of retraction pocket/cholesteatoma. Ossicular status incus long process and incudostapedial joint necrosed. Sickle pointing towards eroded long process. Incudostapedial joint missing and head of stapes reflecting through residual tympanic membrane. To visualize the extent of cholesteatoma medial to the body of incus, the incus is avulsed out with the help of sickle knife. Incus harvested is held in either ossicle-holding forceps or artery forceps. Long process of incus is found eroded.

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