The Prosthesis

The microscope is positioned to allow a good view of both the incus and footplate. This is best accomplished by pulling the head of the microscope toward the surgeon and then refocusing. A 4.0-mm Robinson prosthesis is placed in the depression of the graft and rested against the incus (Fig. 15-12). It is not necessary to measure the distance between the

FIGURE 15-10 Scarification of the mucosa around the footplate for better adhesion.

incus and the vestibule. The distance is very consistent in many anatomic studies done over many years. The prosthesis is a Robinson, 4.0-mm length overall, with a large well (1.0-mm bucket) and a

FIGURE 15-12 The Robinson prosthesis is placed in the depression in the graft over the opening in the stapes footplate and rested against the incus.

narrow (0.4 mm) stem. Irrespective of the side, an incus hook is taken in the left hand and a strut guide in the right. The hands are steadied against the speculum holder. The hook is placed anterior to and beneath the incus but no attempt made to pull it laterally. The strut guide engages the prosthesis and is used to manipulate it beneath the incus. As the prosthesis approaches the lenticular process, the hook is used to steady and minutely lift the incus (Fig. 15-13). Once underneath the lenticular process, the incus hook is released and the prosthesis tends to snap onto the lenticular process. In case of difficulty, the positioning of the prosthesis can be done with one hand, but this disturbs the vestibule more than is desirable.

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