Abstract
Knowledge of the vascularization of the malleus may help to better understand some unwanted effects occurred in those surgical techniques using the handle as an attachment site of ossicle-replacement prostheses. Our hypothesis is that vascular damage occurred in the long process of the malleus during tympanic membrane detachment before fastening a malleovestibulopexy (MVP) prosthesis promotes the lysis of this ossicle at the attachment site. To confirm this premise, we carried out an evolutive and descriptive study of ten MVP procedures as well as a morphological analysis of ten cadaveric mallei using both light and scanning electron microscopies. The arterial supply of the manubrium comes from two main sources: vascular branches that reach this ossicle from the site of insertion of the tensor tympani tendon and small perforating branches which penetrate the bone from arteries of the tympanic membrane that, following the periosteum/perichondrium, they arrange parallel to the bone. The detachment of the tympanic membrane to fasten a MVP prosthesis causes a damage in the periosteal/perichondral vascular supply of the handle as well as micro-trauma on it, which can promote bone resorption at the point of anchorage by osteoclast stimulation. Respect periosteal vascularization of the manubrium may be important to prevent damage in this ossicle caused by some middle ear reconstruction prostheses.
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References
Schuknecht HF, Bartley ML (1986) Malleus grip prosthesis. Ann Otol Rhinol Laryngol 95:531–534
Fisch U, Acar GO, Huber AM (2001) Malleostapedotomy in revision surgery for otosclerosis. Otol Neurotol 22:776–785
Rambousek A, Schlegel CH, Linder TE (2012) From incus bypass to malleostapedotomy: technical improvements and results. J Laryngol Otol 126:995–1002
Magliulo G (2013) Self-crimping superelastic nitinol prosthesis and malleostapedotomy : a temporal bone study. Otolaryngol Head Neck Surg 148:272–276
Park M, Song JJ, Chang MY et al (2014) Malleostapedotomy revisited: the advantages of malleus neck-anchoring malleostapedotomy. Otol Neurotol. 35:1504–1508
Sarac S, McKenna MJ, Mikulec AA et al (2006) Results after revision stapedectomy with malleus grip prosthesis. Ann Otol Rhinol Laryngol 115:317–322
Gibbin KP (1979) The histopathology of the incus after stapedectomy. Clin Otolaryngol Allied Sci 4(5):343–354
Gerlinger I, Tóth M, Lujber L et al (2009) Necrosis of the long process of the incus following stapes surgery: new anatomical observations. Laryngoscope. 119(4):721–726
Nager GT, Nager M (1953) The arteries of the human middle ear, with particular regard to the blood supply of the auditory ossicles. Ann Otol Rhinol Laryngol 62:923–949
Alberti PW (1965) The blood supply of the long process of the incus and the head and neck of stapes. J Laryngol Otol 79(11):966–970
Hamberger CA, Wersaell J (1964) Vascular supply of the tympanic membrane and the osicular chain. Acta Otolaryngol Suppl 188(Suppl 188):308
Anson BJ, Harper DG, Winch TR (1964) Intra-osseous blood supply of the auditory ossicles in man. Trans Am Otol Soc 52:44–58
Hamberger CA, Marcuson G, Wersall J (1963) Blood vessels of the ossicular chain. Acta Otolaryngol Suppl 183:6–70
Schimanski G (1997) Erosion and necrosis of the long process of the incus after otosclerosis operation. HNO 45(9):682–689
Chien W, Northrop C, Levine S et al (2009) Anatomy of the distal incus in humans. J Assoc Res Otolaryngol 10(4):485–496
Maher WP (1988) Microvascular networks in tympanic membrane, malleus periosteum, and annulus perichondrium of neonatal mongrel dog: a vasculoanatomic model for surgical considerations. Am J Anat 183(4):294–302
Bakker A, Klein-Nulend J, Burger E (2004) Shear stress inhibits while disuse promotes osteocyte apoptosis. Biochem Biophys Res Commun 320:1163–1168
Reyes Garcia R, Muñoz-Torres M, Cathepsin K (2008) Biological aspects and therapeutic possibilities. Med Clin (Barc) 131(6):218–220
Verborgt O, Tatton NA, Majeska RJ, Schaffler MB (2002) Spatial distribution of Bax and Bcl-2 in osteocytes after bone fatigue: complementary roles in bone remodeling regulation? J Bone Miner Res 17:907–914
Martin RB (2007) Targeted bone remodeling involves BMU steering as well as activation. Bone 40:1574–1580
Aguirre JI, Plotkin LI, Stewart SA et al (2006) Osteocyte apoptosis is induced by weightlessness in mice and precedes osteoclast recruitment and bone loss. J Bone Miner Res 21:605–615
Gu G, Mulari M, Peng Z et al (2005) Death of osteocytes turns off the inhibition of osteoclasts and triggers local bone resorption. Biochem Biophys Res Commun 335:1095–1101
Chen H, Okumura T, Emura S, Shoumura S (2008) Scanning electron microscopic study of the human auditory ossicles. Ann Anat 190(1):53–58
Häusler R, Steinhart U (2007) A new self-fixing and articulated malleus grip stapedectomy prosthesis. Adv Otorhinolaryngol 65:197–201
Kwok P, Fisch U, Nussbaumer M et al (2009) Morphology of the malleus handle and the comparison of different prostheses for malleostapedotomy. Otol Neurotol 30(8):1175–1185
Magliulo G, Ciniglio Appiani M, Colicchio MG et al (2013) Malleostapedotomy with a self-crimping superelastic nitinol prosthesis. Laryngoscope 123(2):492–495
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Vallejo-Valdezate, L.A., Herrero-Calvo, D. & Garrosa-García, M. Vascularization of the long process of the malleus: surgical implications. Eur Arch Otorhinolaryngol 273, 2335–2342 (2016). https://doi.org/10.1007/s00405-015-3787-2
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DOI: https://doi.org/10.1007/s00405-015-3787-2