0:01

This is another patient who had a

0:03

mastoidectomy for cholesteatoma.

0:07

And this gives us the opportunity to see what

0:10

ossicular replacement surgery looks like.

0:13

So here we see that the patient has

0:15

had a simple mastoidectomy.

0:17

You can see the defect of the mastoidectomy

0:20

demonstrated along here.

0:22

How much of this soft tissue is secondary to

0:27

the cholesteatoma versus granulation tissue,

0:31

we won't rely on the MRI scan.

0:34

However,

0:35

for the purposes of this demonstration,

0:37

what I'd like to show you is that there are no

0:39

ossicles identified in the middle ear cavity.

0:42

What we do have is something which is going

0:44

from a thickened tympanic membrane and coming

0:49

across to the oval window that

0:52

does not look like a stape.

0:55

So what I'm talking about,

0:57

and we'll get the annotation here,

1:00

is this structure right here,

1:03

which is going from a thickened tympanic

1:05

membrane and is going to be heading medially.

1:09

So here you can see it coming medially to

1:13

insert along the region of the oval window.

1:16

Here's our vestibule,

1:19

and here's that soft tissue.

1:20

Again, let me try to annotate this.

1:25

I'm talking about this stuff right here.

1:28

And that is what's called a total ossicular

1:32

replacement prosthesis. Why is it total?

1:35

Well, we don't see the malleus,

1:36

we don't see the incus,

1:37

and we don't see the stapes.

1:39

There are partial ossicular replacement

1:42

prostheses, so-called PORPs.

1:45

But in this case,

1:47

what we're seeing is the total ossicular replacement

1:51

prosthesis going sequentially to

1:55

the tympanic membrane.

1:55

Now, this is not a normal tympanic membrane.