To begin, prepare all the necessary surgical tools and equipment for the procedure After elevation of the tympanomeatal flap and establishing access to the middle ear, use a needle dissector to detach the chorda tympani from the long process of the incus. Then slightly resect the scutum with the ultrasonic device or a bone curette. Identify the incudostapedial joint and cautiously disarticulate the lenticular process from the stapes head using a micro hook or a small round knife.
Then gently push the incus upward to detach it from the head of the malleus. and remove the incus by pulling the long process inferiorly and then laterally. To grind the graft, hold the inus using a grasping forceps and use a diamond bur to carefully drill both the long and short processes of the incus until the level of the incus body is reached.
On the opposite side of the former long process, drill an acetabulum approximately one millimeter wide to accommodate the stapes head. Next, position the remodeled incus inside the tympanic cavity. Using a microsuction tip or a needle, precisely locate the acetabulum onto the stapes head, and if appropriate, the anterior surface in contact with the malleus handle.
Stabilize the incus into position using resorbable gelatin sponges, and close the tympanomeatal flap. The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 25.24 decibels, whereas after surgery, the average air-bone gap significantly reduced to 17.10 decibels.
