Position of the surgeon in stapes surgery.

Abstract

Exposure of the posterior tympanic compartment via a posterior tympanotomy incision has become a standard practice in stapes surgery. (The incision and exposure were originally advocated by Lempert¹as an approach to tympanosympathectomy.) Experiences with the conventional arrangement in which the surgeon makes the incision standing or sitting posteriorly to the patient have revealed definite anatomical inadequacies, since the surgeon's vision naturally is directed to the anterior canal wall and the anterior tympanic compartment. Because of the angle of vision the surgeon must in effect look backward to visualize the posterior canal wall. If he uses straight oculars the effect is further increased (Fig. 1). Good exposure of the stapedial tendon, eminentia pyramidalis, posterior aspect of footplate, and posterior crus, is frequently difficult because of the degree of annular overhang. A good deal of blind curettage of annulus is necessary and frequently results in unnecessary trauma to chorda tympani.