Document Detail

Fisch's reversal steps stapedotomy: when to use it?
MedLine Citation:
PMID:  19816228     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine that the use of Fisch's reversal steps stapedotomy is recommended only when the visible portion of the footplate is blue in all its points before removing the stapes superstructure. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: This study started on January 2007 and ended on June 2007, when the statistical data reached significance. Fifty patients with otosclerosis were examined. Four otosclerosis were excluded from the study following the exclusion criteria indicated by Fisch (obliterative otosclerosis and narrow oval niche). Finally, 46 otosclerosis patients were considered for the study. For all patients, stapedotomy procedures using the reversal steps technique by Fisch were planned. The study group was divided into 2 groups (A and B) on the basis of the footplate color before removing the stapes superstructure. Group A included otosclerosis with blue footplate (n = 34). Group B included otosclerosis with white footplate (n = 12). We estimated whether the reversal steps stapedotomy proposed by Fisch significantly avoids incus complications (luxation and subluxation) and stapes footplate complications (luxation and fracture) both in blue and white otosclerosis. MAIN OUTCOME MEASURES: Footplate color, incidence of complications. RESULTS: The footplate fenestration had not caused fractures or luxation of footplate in both groups. The fracture of the anterior crus had caused 5 footplate complications (2 luxations and 3 fractures) in Group B, but none in Group A. This difference was significant. In Group A, we had no subluxation/luxation of the incus. In Group B, we had 3 incus subluxations. This difference was significant. CONCLUSION: The use of Fisch's reversal steps stapedotomy is recommended only when the visible portion of the footplate, before removing the stapes superstructure, is blue in all its points, that is, "blue otosclerosis," because only in this case that the original idea of Fisch avoids incus and footplate complications. When the visible portion of the footplate, before removing the stapes superstructure, is white in all or in most of its points, that is, "white otosclerosis," the reversal steps technique by Fisch is not recommended because it does not avoid incus luxation/subluxation and footplate complications (fracture and luxation of the anterior half).
Giuseppe Malafronte; Barbara Filosa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology     Volume:  30     ISSN:  1537-4505     ISO Abbreviation:  Otol. Neurotol.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2010-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100961504     Medline TA:  Otol Neurotol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1128-30     Citation Subset:  IM    
Department of Otolaryngology Head and Neck Surgery, S. G. Moscati Hospital, Avellino, Italy.
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MeSH Terms
Incus / injuries,  pathology,  surgery
Intraoperative Complications / epidemiology
Middle Aged
Otosclerosis / classification,  pathology,  surgery*
Postoperative Complications / epidemiology
Prospective Studies
Stapes / pathology
Stapes Surgery / contraindications,  methods*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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