Issue N# 3 - 2013
Lysis of the incus long process and incudostapedial rebridging ossiculoplasty: Comparative study of titanium-gold angle prosthesis Plester-type versus Martin Incudo Prosthesis Hydroxylapatite
Authors : Faye MB, Martin C, Schmerber S. (Dakar)
Ref. : Rev Laryngol Otol Rhinol. 2013;134,3:125-130.
Article published in french
Downloadable PDF document french
Objectives: We report two surgical techniques devised to restore a disrupted incudostapedial joint. Material and methods: Thirty patients underwent rebridging of distal portion of incus long process in the ENT Department of University of Grenoble and Saint-Etienne, between October 1998 and September 2002. Two types of ossicular prostheses were used: A titanium-gold angle prosthesis according to Plester Winkl Kurtz® (n= 16 patients), and a hydroxylapatite prosthesis as Martin Incudo Prosthesis (n= 14 patients). Results: The average hearing gain in short term is of 8.30 dB for the Martin-Incudo group. It is of 5.23 dB in the Winkel group. Seven and three cases of failures (Residual Rinne > 20dB) were noticed respectively in the groups Martin-Incudo and Winkel. Seven and four cases of labyrinthisation were observed respectively in the groups Martin-Incudo and Winkel. The average hearing gain in long term is 3.43 dB in the Martin-Incudo group ; and 2.85 dB among patients with Winkel Kurz® prosthesis. Average residual Rinne is higher than 20 dB in the Winkel group. The hearing gain is not statistically significant between the two groups (p > 0.05). Conclusion: The titanium partial prosthesis did not give good functional results. In the case of a limited lysis (< 2 mm) of the distal portion of incus, we use the cement or cartilage interposition. When ossicular chain cannot be preserved entirely, we privilege incus transposition or a titanium PORP. The Martin-Incudo prosthesis seems interesting in the event of lysis of 2 mm of the long process of incus, nevertheless engineering changes are necessary in order to make rigid the incudostapedial joint.
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