Surgical and Radiologic Anatomy

, Volume 41, Issue 7, pp 833–839 | Cite as

Evaluation of the stapedial tendon growth dynamic in human fetuses

  • Orhan BegerEmail author
  • Turan Koç
  • Meryem İlkay Karagül
  • Deniz Ladin Özdemir
  • Fatma Müdüroğlu
  • Diana Georgiana Cintacioiu
  • Hong Thai Le
  • Yusuf Vayisoğlu
  • Şakir Necat Yılmaz
  • Zeliha Kurtoğlu Olgunus
  • Derya Ümit Talas
Original Article



The main objective of the study was to investigate the morphometric properties of the stapedial tendon (ST) for pediatric otosurgeons and anatomists.


The present study was placed on 15 fetuses (8 females, 7 males) aged from 20 to 30 weeks of gestation (at mean, 24.27 ± 3.24 weeks) using the collection of the Anatomy Department of Medicine Faculty, Mersin University. All measurements were obtained with a digital image analysis software.


In terms of male/female or right/left comparisons, no statistically significant difference was found in relation with the numerical data of ST. The surface area, length, and width of ST were detected as follows: 0.61 ± 0.15 mm2, 1.27 ± 0.30 mm, and 0.45 ± 0.08 mm, respectively. The absence of ST was observed in two fetuses with and without severe malformations. In another fetus with cleft lip and polydactyly, multiple abnormalities were bilaterally identified in the middle ear: (1) the absence of the incudostapedial joint and (2) the presence of an abnormal tissue attaching to the stapes. The abnormal tissue was determined to be irregular dense connective tissue using light microscope and electron microscope.


Our findings showed that ST did not proportionally grow according to increasing gestational weeks. In the light of the numerical data, we thought that similar to stapes, ST attains the adult size in the fetal period. As ST anomalies may accompany severe malformations (e.g., cleft lip, polydactyly or syndactyly) that can be easily detected on observation by clinicians, we suggest that the detailed examination of middle ear in newborns should be taken into account for early diagnosis of conductive hearing loss to prevent any management delays.


Congenital malformations Fetus Middle ear Stapedial tendon Stapedius muscle 



Deniz Ladin Özdemir, Fatma Müdüroğlu, Diana Georgiana Cintacioiu and Hong Thai Le participated to this study as visiting students.

Author contrubitions

OB, TK, MİK, ŞNY, YV, DÜT, ZKO: Project development, Data collection, Data analysis, Manuscript writing, Manuscript editing. DLÖ, FM, DGC, HTL: Project development, Data collection, Manuscript writing.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest


  1. 1.
    Anson BJ (1946) Development of the auditory ossicles. Laryngoscope 56(10):561–569CrossRefPubMedGoogle Scholar
  2. 2.
    Beger B, Beger O, Koç T, Dinç U, Hamzaoğlu V, Kayan G et al (2018) Quantitative and neurovascular anatomy of the growing gracilis muscle in the human fetuses. J Craniofac Surg 29(7):686–690Google Scholar
  3. 3.
    Beger O, Beger B, Uzmansel D, Erdoğan S, Kurtoğlu Z (2018) Morphometric properties of the latissimus dorsi muscle in human fetuses for flap surgery. Surg Radiol Anat 40(8):881–889CrossRefPubMedGoogle Scholar
  4. 4.
    Beger O, Dinç U, Beger B, Uzmansel D, Kurtoğlu Z (2018) Morphometric properties of the levator scapulae, rhomboid major, and rhomboid minor in human fetuses. Surg Radiol Anat 40(4):449–455CrossRefPubMedGoogle Scholar
  5. 5.
    Beger O, Koç T, Beger B, Kayan G, Uzmansel D, Olgunus ZK (2018) Quantitative assessment of the growth dynamics of the teres major in human fetuses. Surg Radiol Anat 40(12):1349–1356CrossRefPubMedGoogle Scholar
  6. 6.
    Beger O, Koç T, Beger B, Özalp H, Hamzaoğlu V, Vayisoğlu Y et al (2018) Multiple muscular abnormalities in a fetal cadaver with CHARGE syndrome. Surg Radiol Anat. CrossRefPubMedGoogle Scholar
  7. 7.
    Beger O, Koç T, Beger B, Uzmansel D, Kurtoğlu Z (2018) Morphometric properties of the tensor fascia lata muscle in human fetuses. Folia Morphol (Warsz) 77(3):498–502CrossRefGoogle Scholar
  8. 8.
    Cheng T, Gan RZ (2007) Mechanical properties of stapedial tendon in human middle ear. J Biomech Eng 129(6):913–918CrossRefPubMedGoogle Scholar
  9. 9.
    Cutts A (1988) Shrinkage of muscle fibres during the fixation of cadaveric tissue. J Anat 160:75–78PubMedPubMedCentralGoogle Scholar
  10. 10.
    de Castro Rodrigues A, Shinohara AL, Andreo JC, Buchaim RL, Ahmed FJ (2012) Surgical anatomy of the human middle ear: an insight into cochlear implant surgery. Surg Radiol Anat 34(6):535–538CrossRefGoogle Scholar
  11. 11.
    Golz A, Fradis M, Martzu D, Netzer A, Joachims HZ (2003) Stapedius muscle myoclonus. Ann Otol Rhinol Laryngol 112(6):522–524CrossRefPubMedGoogle Scholar
  12. 12.
    Hoshino T, Paparella MM (1971) Middle ear muscle anomalies. Arch Otolaryngol 94(3):235–239CrossRefPubMedGoogle Scholar
  13. 13.
    Hough JVD (1958) Malformations and anatomical variations seen in the middle ear during the operation for mobilization of the stapes. Laryngoscope 68:1337–1379CrossRefPubMedGoogle Scholar
  14. 14.
    Kontorinis G, Goetz F, Lenarz T, Schwab B (2011) Ear and further anatomic anomalies in children undergoing stapedotomy. ORL J Otorhinolaryngol Relat Spec 73(2):76–81CrossRefPubMedGoogle Scholar
  15. 15.
    Kopuz C, Turgut S, Kale A, Aydin ME (2006) Absence of both stapedius tendon and muscle. Neurosciences (Riyadh) 11(2):112–114Google Scholar
  16. 16.
    Lemmerling M, Dhooge I, Mollet P, Mortier G, Van Cauwenberge P, Kunnen M (1998) CT of the temporal bone in the CHARGE association. Neuroradiology 40(7):462–465CrossRefPubMedGoogle Scholar
  17. 17.
    Roberson JB, Kunda LD, Stidham KR, Inserra MM, Choe W, Tonokawa L (2006) Modifications of standard cochlear implantation techniques for children under 18 months of age. Cochlear Implants Int 7(4):207–213CrossRefPubMedGoogle Scholar
  18. 18.
    Rodríguez-Vázquez JF (2009) Development of the stapedius muscle and pyramidal eminence in humans. J Anat 215(3):292–299CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rodríguez-Vázquez JF (2016) Middle ear muscles. In: Tubbs RS, Shoja MM, Loukas M (eds) Bergman’s comprehensive encyclopedia of human anatomic variation, 1st edn. Wiley-Blackwell, New Jersey, pp 212–216Google Scholar
  20. 20.
    Rodríguez-Vázquez JF, Mérida-Velasco JR, Verdugo-López S (2010) Development of the stapedius muscle and unilateral agenesia of the tendon of the stapedius muscle in a human fetus. Anat Rec (Hoboken) 293(1):25–31CrossRefGoogle Scholar
  21. 21.
    Silverstein H, Hester TO, Rosenberg SI, Deems DA (1998) Preservation of the stapedius tendon in laser stapes surgery. Laryngoscope 108(10):1453–1458CrossRefPubMedGoogle Scholar
  22. 22.
    Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC (2008) Gray’s anatomy: the anatomical basis of clinical practice. Elsevier, LondonGoogle Scholar
  23. 23.
    Tadaki T, Kamiyama R, Okamura HO, Ohtani I (2003) Anomalies of the auditory organ in trisomy 18 syndrome: human temporal bone histopathological study. J Laryngol Otol 117(7):580–583CrossRefPubMedGoogle Scholar
  24. 24.
    Talas DÜ, Beger O, Koç T, Hamzaoğlu V, Özalp H, Mavruk M et al (2019) Morphometric properties of the facial nerve in fetal temporal bones. Int J Pediatr Otorhinolaryngol 116:7–14CrossRefPubMedGoogle Scholar
  25. 25.
    Wasano K, Kanzaki S, Ogawa K (2014) Bilateral congenital conductive hearing loss due to ossification of the stapedius tendon. Otol Neurotol 35(3):119–120CrossRefGoogle Scholar
  26. 26.
    Wright JL, Etholm B (1973) Anomalies of the middle-ear muscles. J Laryngol Otol 87(3):281–288CrossRefPubMedGoogle Scholar
  27. 27.
    Zawawi F, Varshney R, Schloss MD (2014) Shortened stapedius tendon: a rare cause of conductive hearing loss. J Laryngol Otol 128(1):98–100CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Orhan Beger
    • 1
    Email author
  • Turan Koç
    • 1
  • Meryem İlkay Karagül
    • 2
  • Deniz Ladin Özdemir
    • 3
  • Fatma Müdüroğlu
    • 4
  • Diana Georgiana Cintacioiu
    • 5
  • Hong Thai Le
    • 6
  • Yusuf Vayisoğlu
    • 7
  • Şakir Necat Yılmaz
    • 2
  • Zeliha Kurtoğlu Olgunus
    • 1
  • Derya Ümit Talas
    • 7
  1. 1.Department of Anatomy, Faculty of MedicineMersin UniversityMersinTurkey
  2. 2.Department of Histology and Embryology, Faculty of MedicineMersin UniversityMersinTurkey
  3. 3.Faculty of Medicineİstanbul Okan UniversityİstanbulTurkey
  4. 4.Faculty of Medicineİstanbul University-CerrahpaşaİstanbulTurkey
  5. 5.Faculty of MedicineCarol Davila University of Medicine and PharmacyBucharestRomania
  6. 6.Third Faculty of MedicineCharles UniversityPragueCzech Republic
  7. 7.Department of Otorhinolaryngology, Faculty of MedicineMersin UniversityMersinTurkey

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