Traumatic dislocation of the incudostapedial joint repaired with fibrin tissue adhesive

Abstract

We present a case of traumatic dislocation of the incudostapedial joint (ISJ) and a simple method for controlled application of the glue using commercial fibrin tissue adhesive. A 26-year-old female presented to our ENT clinic for hearing impairment to her left ear 2 months after a head trauma due to a motorcycle accident. The audiogram revealed a 40-to 50-dB HL conductive hearing loss with a notch configuration in bone conduction curve on the left ear. Computed tomography of the left temporal bone revealed a longitudinal fracture line. An exploratory tympanotomy was performed under general anesthesia. The ISJ was found dislocated while the incus was trapped by the edges of the bony lateral attic wall fracture. A small bony edge that impeded incus movement was removed and a small amount of the glue was precisely applied to the lenticular process of the incus with an angled incision knife. The long process of the incus was firmly pressed over the stapes for 30 seconds with a 90 hook and 60 seconds after the application of the glue the ISJ was repaired. One year after our patient achieved full airbone gap (ABG) closure (ABG, 10 dB HL), while she demonstrated overclosure in frequencies 2 and 4 kHz. Fibrin tissue glue allowed safe, rapid, and accurate repair of the ISJ and resulted in an anatomically normal articulation as the mass and shape of the ossicles was preserved. Moreover, our patient achieved full ABG closure.

Morphological and Morphometrical Study of the Human Ossicular Chain: A Review of the Literature and a Meta-Analysis of Experience Over 50 Years

“…Solid aplasia of the stapes is very rare whilst many forms of hypoplasia have been described such as a small or absent crura, a blob-like structure, etc. In addition, the incudostapedial disconnection is a very characteristic variation of the articulated ossicles, although it is usually due to traumatic factors [24]. …”

The Influence of Incudostapedial Joint Separation on the Middle Ear Transfer Function

“…It is mainly because the dislocated incus after trauma is not in physiological position. The surfaces of the ISJ are usually separated and need to be approximated and supported [12,13,14]. In temporary ISJ separation during middle ear surgery the position of the ossicles is intact thus it does not require any reconstruction.…”

A case of posttraumatic incudomalleolar disruption

“…[13] The surgical treatment of choice where ossicular disruption is confirmed or suspected is exploratory tympanotomy with subsequent ossicular chain reconstruction when required. Ossiculoplasty can be carried out with autografts (cartilage, ossicle) or other prosthesis, which include high-density polyethylene sponge (Plasti-Pore), aluminum oxide, ceramic, and hydroxyapatite.…”