Traumatic incudostapedial joint disarticulation: anatomical reconstruction versus stapes bypass

Abstract

Objectives: To outline two surgical strategies for managing traumatic incudostapedial joint disarticulation (ISJD) with intact tympanic membrane (TM), aiming for improving the stability and the functional outcomes of the procedure.Patients and Methods: This randomized controlled clinical trial was performed on 27 ears of 27 patients with isolated traumatic ISJD with intact tympanic membrane. The study was conducted in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: anatomical reconstruction group (n=14), and stapes bypass group (using a Teflon piston) (n=13). Air and bone conduction thresholds at frequencies 500–4000 Hz, were determined pre- and postoperatively.Results: The postoperative pure-tone average and mean air-bone gap (ABG) were statistically significantly different (p < 0.001). The mean postoperative gain of air conduction (AC) threshold and consequently the mean postoperative ABG closure were significantly better with the stapes bypass group compared to the bone cement one. ABG closure to within 10 dB in the stapes bypass group was found in 11ears (84.6%), while in bone cement group, closure to within 10 dB was found in 10 (71.4%) and to within 20 dB in 14.2%. The cochlear function remained stable postoperatively in both groups (p=0.422). No complications were reported, and no patient had a postoperative ABG greater than 30 dB.Conclusion: When the ISJ is dislocated, two options exist for ossicular reconstruction: bypassing the stapes using Teflon piston (stapedotomy) and anatomical reconstruction using ionomeric bone cement. Both techniques are successful with no statistically significant difference regarding hearing outcomes.