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OSSICULAR RECONSTRUCTIONSasan Dabiri, M.D.
Assistant Professor
Department of ORL-HNS
Amir Alam Hospital - TUMS
CLASSIFICATION
Wullstein classified the middle ear operations as types I through V, based on
concepts of sound transformation at OW and sound protection of RW
A modified version of Wullstein's classification for tympanoplasty (1990):
o Type 1: Repair of TM without altering the Ossicular system
o Type 2: Repair of TM & Ossicular chain with restoring Lever mechanism
o Type 3: Repair of TM with direct Transduction from TM to Stapes
o Type 4: Repair of TM with direct Connection of TM in mobile foot plate
o Type 5: Repair of TM with direct Connection of TM in fixed foot plate
Horst Ludwig Wullstein
German ENT Surgeon
1906 - 1987
TYPE 2 TYMPANOPLASTY
Preserving Lever mechanism
Reconstruction with:
o Synthetic Prosthesis
o Bone Strut
o Bone Cement
TYPE 3 TYMPANOPLASTY
o Stapes Columella
Direct connection between
Tympanic Membrane &
Capitulum of Stapes
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
Interposition
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
Interposition
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
Interposition
Inposition
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
Synthetic: PORP
Biomaterials
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
o Major Columella
Synthetic: TORP
Biomaterials (Incus TORP)
TYPE 4 TYMPANOPLASTY TYPE 5 TYMPANOPLASTY
o Major Columella
REFERENCES
Nadol Jr. JB, McKenna MJ. Surgery of the ear and temporal bone, 2nd edition, 2005,
Lippincut Williams & Wilkins, Philadelphia, USA
Tos M. Manual of middle ear surgery – volume 1, 1st edition, 1993, Thieme Medical
Publishers, New York, USA
http://de.wikipedia.org/wiki/Horst_Ludwig_Wullstein (last accessed: May 2015)
http://imglisting.com/ear-bone-disease.html (last accessed: May 2015)
http://www.bornwithcholesteatoma.net/prosthetic-bone-devices/ (last accessed: May 2015)
THANKS FOR YOUR ATTENTION
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