Online first
Original article
Published online: 2023-08-04

open access

Page views 344
Article views/downloads 338
Get Citation

Connect on Social Media

Connect on Social Media

Variation of the stapes and its surrounding anatomical structures based on micro-computed tomography

Li Gong1, Yiwei Feng1, Xianglong Tang1, Wenwen Zhou1, Songhua Tan1, Anzhou Tang1

Abstract

Background: Stapedotomy is the most efficient treatment for otosclerosis. The anatomical structure of the operation area is complex, but it has a great impact on the postoperative effect. We measure the anatomical parameters of the stapes and its surrounding structures to provide an anatomical reference for stapes surgery in otosclerosis. Materials and methods: Fifteen adult cadaver heads (30 samples) were scanned using micro-CT. The stapes, facial nerve and external auditory canal were reconstructed by image processing. The stapes parameters and relationships between the stapes and surrounding structures were measured using a three-dimensional reconstruction model. Results: The length, width and thickness of the stapes footplate were 2.93 ± 0.17 mm, 1.46 ± 0.08 mm and 0.30 ± 0.11 mm, respectively. The distance between the stapes footplate and long process of the incus was 3.79±0.39 mm. The angle of the incudostapedial joint was 88.29 ± 11.58°. The distance from the center of the stapes footplate to the facial canal was 1.60 ± 0.34 mm. In simulated stapes surgery, the minimum depth of the external auditory canal to be removed was 2.17 ± 0.91 mm, and no significant difference was found between the left and right sides and between men and women (P > 0.05). Conclusions: A three-dimensional model of the stapes bone and its surrounding anatomical structures was established based on Micro-CT imaging. Anatomical parameters of the stapes bone and its surrounding structures were measured using the model. In stapedotomy, the implanted piston diameter should be around 0.6mm, with a length of approximately 4.6mm. Care should be taken to protect the facial nerve canal during the surgery. These data provide reference for otologists.

Article available in PDF format

View PDF Download PDF file

References

  1. Ahmad N, Wright A. Three-dimensional temporal bone reconstruction from histological sections. J Laryngol Otol. 2014; 128(5): 416–420.
  2. Backous DD, Minor LB, Aboujaoude ES, et al. Relationship of the utriculus and sacculus to the stapes footplate: anatomic implications for sound-and/or pressure-induced otolith activation. Ann Otol Rhinol Laryngol. 1999; 108(6): 548–553.
  3. Bartel R, Sanz JJ, Clemente I, et al. Endoscopic stapes surgery outcomes and complication rates: a systematic review. Eur Arch Otorhinolaryngol. 2021; 278(8): 2673–2679.
  4. Benson JC, Carlson ML, Lane JI. MRI of the internal auditory canal, labyrinth, and middle ear: how we do it. Radiology. 2020; 297(2): 252–265.
  5. Bernardeschi D, De Seta D, Canu G, et al. Does the diameter of the stapes prosthesis really matter? A prospective clinical study. Laryngoscope. 2018; 128(8): 1922–1926.
  6. Cheng HCS, Agrawal SK, Parnes LS. Stapedectomy versus stapedotomy. Otolaryngol Clin North Am. 2018; 51(2): 375–392.
  7. Cuny P, Alsolami NJ, Dobrev I, et al. Influence of angular positioning of the prosthesis in stapes surgeries with a NiTiBond prosthesis: Investigation in cadaveric temporal bones. Hear Res. 2019; 378: 149–156.
  8. Cureoglu S, Baylan MY, Paparella MM. Cochlear otosclerosis. Curr Opin Otolaryngol Head Neck Surg. 2010; 18(5): 357–362.
  9. Dahm MC, Shepherd RK, Clark GM. The postnatal growth of the temporal bone and its implications for cochlear implantation in children. Acta oto-laryngologica Supplementum. 1993;505:1-39. Epub 1993/01/01. Acta Otolaryngol Suppl. 1993; 505: 1–39.
  10. Gielkens PFM, Schortinghuis J, de Jong JR, et al. A comparison of micro-CT, microradiography and histomorphometry in bone research. Arch Oral Biol. 2008; 53(6): 558–566.
  11. Grewe J, Thiele C, Mojallal H, et al. New HRCT-based measurement of the human outer ear canal as a basis for acoustical methods. Am J Audiol. 2013; 22(1): 65–73.
  12. Gristwood RE, Venables WN. Effects of fenestra size and piston diameter on the outcome of stapes surgery for clinical otosclerosis. Ann Otol Rhinol Laryngol. 2011; 120(6): 363–371.
  13. Haußmann A, Yilmaz U. Anatomy of the petrous portion of the temporal bone. Radiologe. 2019; 59(12): 1058–1063.
  14. Kaftan H, Böhme A, Martin H. Geometric parameters of the ossicular chain as a function of its integrity: a micro-CT study in human temporal bones. Otol Neurotol. 2015; 36(1): 178–183.
  15. Malafronte G, Filosa B. Fisch's reversal steps stapedotomy: when to use it? Otol Neurotol. 2009; 30(8): 1128–1130.
  16. Marchese MR, Cianfrone F, Passali GC, et al. Hearing results after stapedotomy: role of the prosthesis diameter. Audiol Neurootol. 2007; 12(4): 221–225.
  17. Nazarian R, McElveen JT, Eshraghi AA. History of Otosclerosis and Stapes Surgery. Otolaryngol Clin North Am. 2018; 51(2): 275–290.
  18. de Oliveira Penido N, de Oliveira Vicente A. Medical management of otosclerosis. Otolaryngol Clin North Am. 2018; 51(2): 441–452.
  19. Quesnel AM, Ishai R, McKenna MJ. Otosclerosis: temporal bone pathology. Otolaryngol Clin North Am. 2018; 51(2): 291–303.
  20. Roychaudhuri BK, Roychowdhury A, Ghosh S, et al. Study on the anatomical variations of the posterosuperior bony overhang of external auditory canal. Indian J Otolaryngol Head Neck Surg. 2011; 63(2): 136–140.
  21. Sennaroğlu L, Unal OF, Sennaroğlu G, et al. Effect of teflon piston diameter on hearing result after stapedotomy. Otolaryngol Head Neck Surg. 2001; 124(3): 279–281.
  22. Sevy A, Arriaga M. The stapes prosthesis: past, present, and future. Otolaryngol Clin North Am. 2018; 51(2): 393–404.
  23. Sim JH, Röösli C, Chatzimichalis M, et al. Characterization of stapes anatomy: investigation of human and guinea pig. J Assoc Res Otolaryngol. 2013; 14(2): 159–173.
  24. Skinner M, Honrado C, Prasad M, et al. The incudostapedial joint angle: implications for stapes surgery prosthesis selection and crimping. Laryngoscope. 2003; 113(4): 647–653.
  25. Srivastava R, Cho W, Fergie N. The use of lasers in stapes surgery. Ear Nose Throat J. 2021; 100(1_suppl): 73S–76S.
  26. Takahashi H, Sando I. Three-dimensional surgical anatomy for stapes surgery computer-aided reconstruction and measurement. Laryngoscope. 1992; 102(10): 1159–1164.
  27. Tang YK, He G, Fan JG, et al. The study of locating facial nerve precisely in middle ear surgery based on clinical anatomy. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017; 31(17): 1334–1337.
  28. Ueda H, Kishimoto M, Uchida Y, et al. Factors affecting fenestration of the footplate in stapes surgery: effectiveness of Fisch's reversal steps stapedotomy. Otol Neurotol. 2013; 34(9): 1576–1580.
  29. Wojciechowski T, Skadorwa T, Fermi M, et al. Radiologic evaluation and clinical assessment of facial sinus in adults and children — computed tomography study. Auris Nasus Larynx. 2023 [Epub ahead of print]; 51(1): 189–197.
  30. Wojciechowski T, Skadorwa T, Nève de Mévergnies JG, et al. Microtomographic morphometry of the stapedius muscle and its tendon. Anat Sci Int. 2020; 95(1): 31–37.
  31. Yu JF, Lee KC, Wang RH, et al. Anthropometry of external auditory canal by non-contactable measurement. Appl Ergon. 2015; 50: 50–55.
  32. Yuyan G, Dongdong R, Chao H. Significance of the measurement of normal Chinese adult stapes. Chinese Journal of Ophthalmology and Otorhinolaryngology. 2017; 17(01): 16–8.
  33. Zhu F, Sun M, Zhang J, et al. Location of tympanic segment and mastoid segment of facial nerve and prevention of prosopoplegia in operations. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011; 25(7): 314–316.