Endoscopic stapes surgery: focusing on the footplate

By June 7, 2019

Wick, Cameron C.1
1 Department of Otolargynology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.

The learning curve of stapes surgery is in part due to the unique skills required to work on the stapes footplate. The endoscopic approach offers superior visualization of the footplate and can serve as a valuable tool for those acquiring new surgical skills.

This video series highlights four cases of endoscopic stapes surgery for otosclerosis. Attention is given to the footplate work and some scenarios that may be encountered.

Case 1 demonstrates a routine stapedotomy with an ideal fenestration that is 0.1 mm larger than the stapes piston diameter. Case 2 shows some subtleties of the stapedotomy process and management of a stapedotomy that is larger than the ideal size. Case 3 demonstrates conversion to a stapedectomy technique. Case 4 highlights management of a floating footplate with partial displacement into the vestibule. The defect is recognized early and managed without damage to the vestibule.

Footplate work is obviously critical for successful stapes surgery. The endoscopic approach provides good visualization of the footplate and may make learning the necessary skills easier, thereby reducing the learning curve for good outcomes. Additionally, versatility with different footplate techniques can be helpful when deviations from the planned approach occur.