The Influence of the Sequence of Surgical Steps on Complications Rate in Stapedotomy

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To assess whether the incidence of complications of stapes surgery depended on the sequence of surgical steps and CO2 laser use in stapes surgery.

Study Design and Setting:

Retrospective and prospective analysis of 420 consecutive stapedotomies was set in tertiary referral University Hospital.


376 patients with otosclerosis in whom 420 primary stapedotomies were performed.


Stapedotomy under local anesthesia using manual perforators and CO2 laser.

Main Outcome Measure:

The incidence of incus subluxation, floating footplate during stapedotomy.


Comparison of the incidence of incus luxation in groups with the piston inserted after removal of the stapes arch, and groups with the piston inserted on the intact ossicular chain showed statistical significance. In the group where perforation of the footplate was performed after removal of the stapes arch floating footplate occurred more often than in groups with reversed sequence of steps.


Perforation of the footplate before removal of stapes arch reduces the risk of floating footplate, and placing the prosthesis on the incus before removal of stapes arch reduces the risk of subluxation of the incus. CO2 laser stapedotomy with reversed sequence of steps was the safest method of stapes surgery.

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