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DOI: 10.1055/a-2646-6383
Techniques for Repairing Tegmen Defects When the Ossicles Protrude Above the Floor of the Middle Fossa
Authors
Abstract
Objective
Occasionally, repair of tegmen defects can be complicated by the ossicular chain protruding above the floor of the middle fossa, which traditionally requires disarticulation and reconstruction of the ossicles to manage. This manuscript describes modifications of previously described techniques to address this surgical problem.
Design
Case series.
Participants
In this case series we present three patients with tegmen defect and encephalocele where the ossicles protruded over the floor of the middle fossa. In one instance, a “manhole cover” was created by concentrically layering hydroxyapatite cement around the tegmen defect and placing a piece of calvarium harvested from the bone flap over the defect. In another case, a “bony igloo” was drilled into harvested bone flap and placed over the defect, effectively creating a neo-epitympanum.
Main outcome measures
Hearing preservation, CSF leak recurrence.
Results
No patients had recurrence of their encephalocele and/or CSF leak. No patients required manipulation of the ossicular chain intraoperatively. Hearing returned to normal in one case. Hearing worsened in one case, thought to be related to injury to the inner hair cells of the cochlear or cochlear nerve. Hearing did worsen in another case, thought to be related to pneumolabyrinth.
Conclusions
The “manhole cover” and “bony igloo” techniques are pragmatic solutions to this rare but complex surgical problem.
Publikationsverlauf
Eingereicht: 14. Januar 2024
Angenommen: 22. Juni 2025
Artikel online veröffentlicht:
16. Juli 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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