title: Revision Stapedectomy with Necrosis of the Long Process of the Incus: Does the Degree of Necrosis Matter? A Retrospective Clinical Study.
abstract: OBJECTIVE
  To discuss the different modalities for managing necrosis of the long process of the incus in revision stapedectomy on the basis of the degree of necrosis and compare the results with those reported in the literature.
  
  
  METHODS
  Thirty-six patients underwent revision stapedectomy with the necrosis of the long process of the incus from 2009 to 2016. The patients were divided into three groups on the basis of the degree of necrosis. For group A (minimal necrosis), augmentation technique with bone cement was performed. For group B (partial necrosis), the cement plug technique was performed. For group C (sever necrosis), malleus relocation with malleovestibulopexy was performed using reshaped necrosed incus. Air and bone conduction thresholds at frequencies of 500-3000 Hz were reviewed pre- and postoperatively using conventional audiometry. The air-bone gap (ABG) and bone conduction thresholds were measured.
  
  
  RESULTS
  Postoperative ABG was reduced to <10 dB in 28 cases (77.8%) and <20 dB in all cases (100%). There was no significant change in postoperative bone conduction thresholds. The mean patient follow-up duration was 23 (range, 18-36) months. The cement plug technique was used in 75% of cases.
  
  
  CONCLUSIONS
  Managing necrosis of the long process of the incus in revision stapedectomy should be considered according to the degree of necrosis. The cement plug technique is considered to be a reasonable option in most cases. Malleus relocation with malleovestibulopexy is an effective alternative to prosthesis.
authors.affiliation: Department of Otolaryngology, Mansoura University, Mansoura, Egypt. ghonimmr@icloud.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ghonim
authors.forename: Yousef
authors.initials: Y
authors.lastname: Shabana
authors.forename: Bassem
authors.initials: B
authors.lastname: Ashraf
authors.forename: Mohamed
authors.initials: M
authors.lastname: Salem
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006320:Hearing Tests; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use; D007188:Incus / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D019933:Ossicular Replacement / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006882:Hydroxyapatites; C475044:hydroxyapatite cement