The stapes develops from the second pharyngeal arch during the sixth to eighth week of embryological life. The central cavity of the stapes, the obturator foramen, is due to the presence embryologically of the stapedial artery, which usually regresses in humans during normal development.
Development
Stapes
Stapes | Development
From the second pharyngeal arch during the sixth to eighth week of embryological life. During sixth to eighth week of embryological life. It develops from the second pharyngeal arch during the sixth to eighth week of embryological life It develops from the second pharyngeal arch during the sixth to eighth week of embryological life.
what are the 3 smallest bones in the human body
user
Strapes is one of them
assistant
what is the size of this above bone?
user
Roughly 3 x 2.5mm
assistant
which part of the body is this located?
user
Middle ear of humans
assistant
besides the human, is this bony structure present in other living species in the animal kingdom?
user
It is one of three ossicles in mammals, in non-mammalian four-legged animals its homologous form is called the columella
assistant
what are the functions this bony structure serves?
user
It transmits sound vibrations from the incus to the oval window, a membrane-covered opening to the inner ear.
assistant
are there any variations of this bony structure?
user
It appears to be relatively constant in size in different ethnic groups
assistant
can this bony structure get affected or impaired?
user
Yes, its impairment causes conductive hearing loss
assistant
is there any remedy to solve this?
user
Two common treatments are stapedectomy and stapedotomy
assistant
how is the first treatment that you mentioned - carried out?
user
It is the surgical removal of the stapes and replacement with an artificial prosthesis
assistant
what are some of the complications involved?
user
Causes fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base.
assistant
what does the term otosclerosis mean?
user
A condition where one or more foci of irregularly laid spongy bone replace part of normally dense enchondral layer of bony otic capsule in the bony labyrinth.
assistant
what is the main difference between the treatment we discussed versus stapedotomy?
user
In the former the Stapes is replaced by artificial prosthesis whereas in the latter an artificial prosthesis is inserted by making a small hole in the base of the stapes
assistant
with reference to the tiny bone discussed earlier, when does the development of it begin?
user
The stapes develops from the second pharyngeal arch during the sixth to eighth week of embryological life. The central cavity of the stapes, the obturator foramen, is due to the presence embryologically of the stapedial artery, which usually regresses in humans during normal development.
Stapes | Development
A modified stapes operation, called a stapedotomy, is thought by many otologic surgeons to be safer and reduce the chances of postoperative complications. In stapedotomy, instead of removing the whole stapes footplate, a tiny hole is made in the footplate - either with a microdrill or with a laser, and a prosthesis is placed to touch this area, oval window. This procedure can be further improved by the use of a tissue graft seal of the fenestra, which is now common practice. Laser stapedotomy is a well-established surgical technique for treating conductive hearing loss due to otosclerosis. The procedure creates a tiny opening in the stapes (the smallest bone in the human body) in which to secure a prosthetic.
Stapedectomy | Stapedotomy
Surgery may be complicated by a persistent stapedial artery, fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base.
Stapes | Clinical relevance
Otosclerosis is a congenital or spontaneous-onset disease characterized by abnormal bone remodeling in the inner ear. Often this causes the stapes to adhere to the oval window, which impedes its ability to conduct sound, and is a cause of conductive hearing loss. Clinical otosclerosis is found in about 1% of people, although it is more common in forms that do not cause noticeable hearing loss. Otosclerosis is more likely in young age groups, and females. Two common treatments are stapedectomy, the surgical removal of the stapes and replacement with an artificial prosthesis, and stapedotomy, the creation of a small hole in the base of the stapes followed by the insertion of an artificial prosthesis into that hole.
Stapes | Clinical relevance
The stapes is commonly described as having been discovered by the professor Giovanni Filippo Ingrassia in 1546 at the University of Naples, although this remains the nature of some controversy, as Ingrassia's description was published posthumously in his 1603 anatomical commentary '. Spanish anatomist Pedro Jimeno is first to have been credited with a published description, in ' (1549). The bone is so-named because of its resemblance to a stirrup (), an example of a late Latin word, probably created in mediaeval times from "to stand" (), as stirrups did not exist in the early Latin-speaking world.
Stapes | History
Comparisons have shown stapedotomy to yield either as good or better results than stapedectomy (measured by hearing improvement and reduction in the air-bone hearing gap, and especially at higher sound frequencies), and to be less prone to complications. In particular, stapedotomy procedure greatly reduces the chance of a perilymph fistula (leakage of cochlear fluid). Stapedotomy, like stapedectomy, can be successful in the presence of sclerotic adhesions (tissue growths abnormally linking the bones to the tympanic cavity), provided the adhesions are removed during surgery. However, the adhesions may recur over time. The stapedotomy method is not applicable in those relatively rare cases that involve scleroris of the entire ossicular chain.
Stapedectomy | Stapedectomy vs. stapedotomy
A stapedectomy is a surgical procedure of the middle ear performed in order to improve hearing. If the stapes footplate is fixed in position, rather than being normally mobile, then a conductive hearing loss results. There are two major causes of stapes fixation. The first is a disease process of abnormal mineralization of the temporal bone called otosclerosis. The second is a congenital malformation of the stapes. In both of these situations, it is possible to improve hearing by removing the stapes bone and replacing it with a micro prosthesis - a stapedectomy, or creating a small hole in the fixed stapes footplate and inserting a tiny, piston-like prosthesis - a stapedotomy.
Stapedectomy | Introduction
Because it is a simpler and safer procedure, stapedotomy is normally preferred to stapedectomy in the absence of predictable complications. However, the success rate of either surgery depends greatly on the skill and the familiarity with the procedure of the surgeon. Furthermore, a major success factor in both surgeries is correctly determining the length of the prosthesis.
Stapedectomy | Stapedectomy vs. stapedotomy
The world's first stapedectomy is credited to Dr. John J.Shea Jr. who performed it in May 1956 on a 54-year-old housewife who could no longer hear even with a hearing aid. Significant contributions to modern stapedectomy techniques were then made by the late Dr. Antonio De La Cruz of the House Ear Institute in Los Angeles; by the late Professor Henri André Martin of the Hôpital Edouard Herriot in Lyon, France, including calibrated platinotomy (stapes footplate rather than whole surgery) and trans-footplate piston surgery that also paved the way for modern stapedotomy; and by the late Dr. Jean-René Causse of the eponymous clinic in Béziers, France, who pioneered the use of Teflon piston prostheses (also critical progress for stapedotomy) and, with his late son Dr.
Stapedectomy | History
There are various methods to treat otosclerosis. However the method of choice is a procedure known as stapedectomy. Early attempts at hearing restoration via the simple freeing of the stapes from its sclerotic attachments to the oval window were met with temporary improvement in hearing, but the conductive hearing loss would almost always recur. A stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it with an implant that is secured to the incus. This procedure restores continuity of ossicular movement and allows transmission of sound waves from the eardrum to the inner ear. A modern variant of this surgery called a stapedotomy, is performed by drilling a small hole in the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis.
Otosclerosis | Surgery
Complications of stapedectomy: When a stapedectomy is done in a middle ear with a congenitally fixed footplate, the results may be excellent but the risk of hearing damage is greater than when the stapes bone is removed and replaced (for otosclerosis). This is primarily due to the risk of additional anomalies being present in the congenitally abnormal ear. If high pressure within the fluid compartment that lies just below the stapes footplate exists, then a perilymphatic gusher may occur when the stapes is removed. Even without immediate complications during surgery, there is always concern of a perilymph fistula forming postoperatively.
Stapedectomy | Complications
A small opening in the drape is then made overlying the incision and yellow hooks utilized to secure the edges of the opening to the edges of the incision, completely covering and isolating the patient's skin. At this point, new instruments and equipment are replaced and the entire prosthesis is inserted through the small opening of the loose drape. The loose drape allows for manipulation of the penis and scrotum required for this procedure without touching the skin.
Phalloplasty | Procedure
Jean-Bernard Causse, the reattachment of the stapedius muscle alongside the use of veinous grafts.
Stapedectomy | History
The stapes is the third bone of the three ossicles in the middle ear. The stapes is a stirrup-shaped bone, and the smallest in the human body. It rests on the oval window, to which it is connected by an annular ligament. The stapes is described as having a base, resting on the oval window, as well as a head that articulates with the incus. These are connected by anterior and posterior limbs (). The stapes articulates with the incus through the incudostapedial joint. The stapes is the smallest bone in the human body, and measures roughly 3 x 2.5mm, greater along the head-base span.
Stapes | Structure
The standard size and shape is retained throughout the number of species, but the variations between species of ornamentation may be due to physiological influences from the environment. Development occurs in two phases within the continuous process. The first phase involves the primary inner wall of the cyst being formed before the collar and surface, which is thin and occurs rapidly from a proximal to distal manner. The second phase is more controlled and occurs more slowly while the wall is being thickened, and the collar and surface ornamentation are being produced. Because of this process of making a stomatocyst, cysts can be found at any stage of development.
Mallomonas | Stomatocyst
The revival of the stapes mobilization operation by Rosen, in 1953, made the use of the microscope mandatory, although it was not used by the originators of the technique, Kessel (1878), Boucheron (1888) and Miot (1890). Mastoidectomies began to be performed with the surgical microscope and so were the tympanoplasty techniques that became known in the early 1950s. The stapes mobilization operation had varying results and was soon replaced by stapedectomy, first described by John Shea, Jr.; this was an operation that was always performed with the microscope. Today neurosurgeons are very proud to use microscopes in their procedures. But it was not always so: many prestigious centers did not accept that idea and it had to be developed in relative isolation.
Microsurgery | History
The results of this surgery are generally most reliable in patients whose stapes has lost mobility because of otosclerosis. Nine out of ten patients who undergo the procedure will come out with significantly improved hearing while less than 1% will experience worsened hearing acuity or deafness. Successful surgery usually provides an increase in hearing acuity of about 20 dB. That is as much difference as having your hands over both ears, or not. However, most of the published results of success fall within the speech frequency of 500 Hz, 1000 Hz and 2000 Hz; poorer results are typically obtained in the high frequencies, but these are normally less hampered by otosclerosis in the first place.
Stapedectomy | Introduction
The CO laser allows the surgeon to create very small, precisely placed holes without increasing the temperature of the inner ear fluid by more than one degree, making this an extremely safe surgical solution. The hole diameter can be predetermined according to the prosthesis diameter. Treatment can be completed in a single operation visit using anesthesia, normally followed by one or two nights' hospitalization with subsequent at-home recovery time a matter of days or weeks.
Stapedectomy | Stapedotomy
The stapes is one of three ossicles in mammals. In non-mammalian four-legged animals, the bone homologous to the stapes is usually called the columella; however, in reptiles, either term may be used. In fish, the homologous bone is called the "hyomandibular", and is part of the gill arch supporting either the spiracle or the jaw, depending on the species. The equivalent term in amphibians is the "".
Stapes | Animals
The bone flap is then propped open using small wedges or pieces of bone such that the enlarged spinal canal will remain in place. This technique contrasts with vertebral laminectomy in the amount of bone and muscle tissue that has to be removed, displaced, or dissected in the procedure.
Laminoplasty | Introduction
The stapedius emerges from a pinpoint foramen in the apex of the pyramidal eminence (a hollow, cone-shaped prominence in the posterior wall of the tympanic cavity), and inserts into the neck of the stapes.
Stapedius muscle | Structure
A much more detailed description of the first two ossicles followed in Andreas Vesalius' "De humani corporis fabrica" in which he devoted a chapter to them. Vesalius was the first to compare the second element of the ossicles to an anvil although he offered the molar as an alternative comparison for its shape. The first published description of the stapes came in Pedro Jimeno's "Dialogus de re medica" (1549) although it had been previously described in public lectures by Giovanni Filippo Ingrassia at the University of Naples as early as 1546. The term "ossicle" derives from , a diminutive of "bone" (; genitive ).
Ossicles | History
The gyne is notably larger than the worker, at approximately long, and has a head that is wider than long when the mandibles are excluded. Also unlike the worker, the eyes are placed at the midpoint of the head, though they are small as the workers are. There are a number of denticles along the chewing margin on the large triangle shaped mandibles. While the scape extends beyond the back of the head, its total length is less than that of the head.
Paraneuretus | "P. dubovikoffi"
The stapes appears to be relatively constant in size in different ethnic groups. In 0.01-0.02% of people, the stapedial artery does not regress, and persists in the central foramen. In this case, a pulsatile sound may be heard in the affected ear, or there may be no symptoms at all. Rarely, the stapes may be completely absent.
Stapes | Variation
For example, the lower branch of the squamosal bone is shortened to offset the tall dorsal process of quadratojugal which connects to it. On the other hand, the rear branch jugal bone lengthens to fill some of the space left by the shortening of the anterior process of the quadratojugal. In archosauriforms, the jugal even re-encloses the lower temporal fenestra. The stapes are long, thin, and solid, without a perforating hole (stapedial foramen) present in the more robust stapes of other reptiles.
Archosauromorpha | Skull
The major exception is when the joint between these bones, the distal radioulnar joint (or DRUJ), is unstable. When the DRUJ is unstable, the ulnar styloid may require independent treatment.
Ulnar styloid process | Introduction
A 3-cm scrotal incision is made on the penoscrotal raphe and carried down through the subcutaneous tissue to the Buck's fascia. A Scott retractor, a flexible device that holds open the skin of the surgical site, is applied to the area. Up until this stage of the surgery, the process has been consistent with the sanitary practices associated with standard surgical sterility. At this stage of the "No-Touch" Technique, after the incision has been made, all instruments, including surgical gloves that have touched skin are discarded. A loose drape is then deployed over the entire surgical field and secured at the periphery with adhesive strips.
Phalloplasty | Procedure
The success rate of either surgery depends greatly on the skill and the familiarity with the procedure of the surgeon. However, comparisons have shown stapedotomy to yield results at least as good as stapedectomy, with fewer complications, and thus stapedotomy is preferred in normal circumstances.
Otosclerosis | Surgery
Occasionally the joints between the ossicles become rigid. One condition, otosclerosis, results in the fusing of the stapes to the oval window. This reduces hearing and may be treated surgically.
Ossicles | Clinical relevance
The tympanic cavity and eustachian tube are derived from the first pharyngeal pouch (a cavity lined by endoderm). The distal part of the cleft, the tubotympanic recess, widens to create the tympanic cavity. The proximal part of the cleft remains narrow and creates the eustachian tube. The bones of the middle ear, the ossicles, derive from the cartilages of the pharyngeal arches. The malleus and incus derive from the cartilage of the first pharyngeal arch, whereas the stapes derives from the cartilage of the second pharyngeal arch.
Human embryonic development | Middle ear
The elongation of the receptacle begins at the base and after its elongation, the gleba hangs suspended from the arch of the receptaculum by medullary tissue constituting the chamber masses of the receptacle.
Clathrus columnatus | Development
These are the most unusual of the braincase bones, and were previously misidentified as stapes. While they are not stapes, it is difficult to be certain what they are. As mentioned, they are sutured to the tubera basioccipitalia, and so could not have moved freely, meaning that they were not bones for the transmission of sound in this manner. Medially, they are sutured to the posterodorsal margins of the tubera basioccipitalia by a strongly serrate and partially intergrown suture. The posterior surface of this forms a steeply inclined trough running from the suture to the distal extremity of the paraoccipital process.
Phantomosaurus | Opisthotic bones
Caudal to what will eventually become the stapes, Reichert's cartilage also forms the styloid process of the temporal bone. The cartilage between the hyoid bone and styloid process will not remain as development continues, but its perichondrium will eventually form the stylohyoid ligament.
Pharyngeal arch | Reichert's cartilage
These differences may have been related to the process and rate at which bone formed.
Gallimimus | Development
In cases when all conservative treatment fails, surgical therapy may be necessary. In a bursectomy the bursa is cut out either endoscopically or with open surgery. The bursa grows back in place after a couple of weeks but without any inflammatory component.
Bursitis | Treatment
Initial prototypes for the workhorses of surgical stapling, the TA and GIA staplers, were created by 1964.
Félicien M. Steichen | Lincoln Hospital: establishing the viability of surgical stapling
The head and segments of the antenna tend to be smaller in the holotype specimen while in the paratype they are slightly larger. The pubescence is short but scattered throughout the body, measuring . The colour of the specimens appears to be light-brown. The metapleural gland exhibits a notably wide and oval-shaped orifice, (openings into the body). The separation between the orifice and the posterior portion of the propodeum is twice the diameter than the orifice itself. The cuticle situated in the anterior portion (referring to what is in front) of the orifice is thinner in contrast to the cuticle surrounding the mesosoma, where it is notably transparent.
Sphecomyrma | "S. freyi"
In 1995, Glasscock et al. published a 25-year single-centre review of over 900 patients who underwent stapedectomy and stapedotomy and found complications rates as follows: reparative granuloma 1.3%, tympanic membrane perforation 1.0%, total sensorineural hearing loss 0.6%, partial sensorineural hearing loss 0.3%, and vertigo 0.3%. In this series, there was no incidence of facial nerve paralysis or tinnitus.
Stapedectomy | Complications
If the periosteum or underlying muscles (frontalis, occipitalis, temporalis) are intact, secondary closure by granulation is possible. Before surgical intervention this was the only option available, as used to treat Robert McGee in 1864. Considering modern aesthetic standards, a better option is the use of split-thickness or full-thickness skin grafts, which is also quicker. When bulk is needed for a better contour a free flap is used, or as shown in the pictures, a regional flap.
Scalp reconstruction | Soft tissue defects
The stapes or stirrup is a bone in the middle ear of humans and other mammals which is involved in the conduction of sound vibrations to the inner ear. This stirrup-shaped bone is connected to the oval window by its annular ligament, which allows the footplate to transmit sound energy through the oval window into the inner ear. The stapes is the smallest and lightest bone in the human body, and is so-called because of its resemblance to a stirrup ().
Stapes | Introduction
The scapes are short, measuring , and the pedicel (the second segment of the antenna) is The flagellomeres vary in length, ranging between . The clypeus is shallow and measures (when excluding the denticles). It is broad, and the distance between its lateral-most denticles is . It is also more concave-shaped than it is straight. The oral margin of the clypeus is lined with a row of 30 denticles, which are peg-shaped. They also have rounded apices. The row of clypeal margin denticles is composed of two short rows. Each row is composed of 15 denticles each. The mandibles are short and barely overlap medially.
Zigrasimecia | "Z. tonsora"
The Stenström technique or method is otoplastic surgery (otoplasty) for pinning protruding ears. The method belongs together with the Mustardé technique and the Converse technique to the traditional or conventional otoplasties.
Stenström technique | Introduction
In scaphocephaly the sagittal suture is prematurely fused, preventing the skull from growing perpendicular to the suture. Thus the head becomes very narrow and long. If a scaphocephaly is diagnosed within 4 to 5 months after birth, it can be corrected with a relatively simple procedure whereby the sagittal suture is surgically reopened. Once the suture has been opened the bone segments will be able to grow again and the head can regain its normal shape. This operation is only performed on patients younger than five months old with a scaphocephaly. This is due to the fact that the bone segments only have the ability to adapt so severely when the operation is performed at this young age.
Craniofacial surgery | Surgical procedures
The configuration of the stapes is intermediate between non-amniote tetrapods and amniotes. On the one hand, its connection to the otic notch is unusual, since true reptiles and other amniotes have lost an otic notch, forcing the tympanum and stapes to shift downwards towards the quadrate bone of the jaw joint. On the other hand, the thin, sensitive structure of "Seymouria"'s stapes is a specialization over most non-amniote tetrapods, which have a thick stapes useless for hearing yet useful for reinforcing the skull. The inner ear of "Seymouria baylorensis" retains a cochlear recess located behind (rather than below) the vestibule, and its anterior semicircular canal was likely encompassed by a cartilaginous (rather than bony) supraoccipital.
Seymouria | Skull
While the mandibles are similar in length to "Pseudectatomma", they are more gracile and the antenna scape is shorter. As such, the species was placed provisionally into "Protopone".
Protopone | "P.? dubia"
Situated between the incus and the inner ear, the stapes transmits sound vibrations from the incus to the oval window, a membrane-covered opening to the inner ear. The stapes is also stabilized by the stapedius muscle, which is innervated by the facial nerve.
Stapes | Function
The outer area is rufous and there is a submarginal dentate line with dark marks on it.
Streptoperas crenelata | Introduction
It is occupied by the base of the stapes, the circumference of which is fixed by the annular ligament to the margin of the foramen.
Oval window | Introduction
Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site. Work to correct the problem in body then proceeds. This work may involve:
Surgery | Intraoperative phase
The basal plate of the epigyne which bears the scape, and which forms a porch or hood that covers the opening of the oviduct is called the "atriolum". A still more complicated form of epigyne is found in some of the sheet weavers (Linyphiidae) and orb weavers (Araneidae), where the ovipositor consists of two finger-like projections: first, the more common one, the scape, which arises from the atriolum, and consequently in front of the opening of the oviduct; and second, one which arises behind the opening of the oviduct; this is termed the "parmula". Each of these projections may be grooved on the side facing the oviduct, forming a tube.
Epigyne | Differences in form
After obtaining the informed consent from the patient, local anesthesia is given. Anterior chamber entry (eye entry) is made by a blade in the superior corneo-limbus area. Descemet's membrane along with endothelium in the patient is removed mechanically by reverse Sinskey hook by controlled stripping on the endothelial side (Fig 3A-C).
Pre-Descemet's Endothelial Keratoplasty | Host Bed Preparation
Then the graft is attached to the overlying host stroma pneumatically (Fig 3E,F). Air fluid pressure is maintained inside the chamber for 60 seconds and then minimal air is released. The wound is closed with 10-0 monofilament suture and subconjunctival antibiotic steroid injection is given.
Pre-Descemet's Endothelial Keratoplasty | Graft Injection into Host Bed
An alisphenoid strut separates two foramina (openings) at the base of the skull, the buccinator-masticatory foramen and the foramen ovale accessorium. The pattern of grooves and foramina on the head indicates that the circulation of the arteries in the head of "T. ucucha" follows the primitive pattern. The tegmen tympani, the roof of the tympanic cavity, overlaps the suspensory process of the squamosal bone. At the back of the mandible (lower jaw), there is a capsular process to receive the root of the lower incisor, which is absent in "T. hylophilus".
Thomasomys ucucha | Description
Funding goals to begin the restoration fell short, and efforts to restore the work did not begin at that time.
Gastrotypographicalassemblage | Introduction
The base of the acromion is formed by an extension from the spine; the two nuclei of the acromion unite, and then join with the extension from the spine. The upper third of the glenoid cavity is ossified from a separate center (sub coracoid), which appears between the 10th and 11th years and joins between the 16th and the 18th years. Further, an epiphysial plate appears for the lower part of the glenoid cavity, and the tip of the coracoid process frequently has a separate nucleus. These various epiphyses are joined to the bone by the 25th year.
Scapula | Development
The dorsal process of the stapes in "Theriognathus" is greatly reduced or entirely absent. The dentary is short, shaped like a banana, and continuously tapers anteriorly to a narrow edge. The dentarys’ lateral surface is smooth. The posterodorsal terminal end of the coronoid process is more rounded, and the dorsal extent terminates below the middle of the orbit in adults. The postdentary bones are reduced to form a free standing coronoid process. The reflected lamina is spade shaped and does not extend below the dentary The area between left and right dentaries remains relatively long and narrow just posterior to symphyseal region.
Theriognathus | Lower jaw
Infants at the age of six months are recommended to have a prosthetic mitten fitted; enabling them to get used to the prosthesis. A hook will be added when the child reaches the age of two years. Eventually the patient may receive a myoelectric prosthetic limb. Patients are treated in this way due to the lack of understanding at a young age and the absence of necessary tissues and bones to hold the prosthetic limb.
Phocomelia | Treatment
Because of the experimental character of this surgery some chose to remain as they were and others could just not be helped yet. Some of the latter were helped by all kinds of new prosthetics to make them look more or less 'normal'.
Gueules cassées | Background
The new urethral meatus is placed along the neophallus to the distal end and the skin of the neophallus and scrotum reconstructed using labia minora and majora flaps. The new neophallus ranges in size from 4–10 cm (with an average of 5.7 cm) and has the approximate girth of a human adult thumb.
Metoidioplasty | Introduction
This species is likely now extinct.
Theliderma stapes | Conservation
The temporal fascia is harvested. An incision is made to raise medial meatal skin with tympanic membrane epithelium. The graft is placed on the outer surface of the tympanic membrane and a slit is made to tuck it under the handle of malleus. The ear is packed with gelfoam and antibiotics, and the incision is closed. Finally mastoid dressing is performed.
Myringoplasty | Overlay technique
The technique of this surgery was described by Stenström in 1963 and was slightly altered by him in 1973.
Stenström technique | History
Preputioplasty or prepuce plasty, also known as "limited dorsal slit with transverse closure", is a plastic surgical operation on the prepuce or foreskin of the penis, to widen a narrow non-retractile foreskin which cannot comfortably be drawn back off the head of the penis in erection because of a constriction (stenosis) which has not expanded after adolescence. Preputioplasty is a treatment for phimosis in the alternative to circumcision and radical dorsal slit
Preputioplasty | Introduction
When the person enters the operating room, the skin surface to be operated on, called the operating field, is cleaned and prepared by applying an antiseptic (ideally chlorhexidine gluconate in alcoholic, as this is twice as effective as povidone-iodine for reduce the risk of infection. If hair is present at the surgical site, it is clipped off prior to prep application. The person is assisted by an anesthesiologist or resident to make a specific surgical position, then sterile drapes are used to cover the surgical site or at least a wide area surrounding the operating field; the drapes are clipped to a pair of poles near the head of the bed to form an "ether screen", which separates the anesthetist/anesthesiologist's working area (unsterile) from the surgical site (sterile).
Surgery | Staging for surgery
Sutures are then placed and the divided varices are occluded. The muscle layer is then reattached. A nasogastric tube is left "in situ", and the mediastinum is closed.
Sugiura procedure | Thoracic operation
Because there are three handtypes in Apert, all with their own deformities, they all need a different approach regarding their treatment: With growing of a child and respectively the hands, secondary revisions are needed to treat the contractures and to improve the aesthetics.
Apert syndrome | Syndactyly
The resulting new head-to-ear distance doesn’t always meet the individual expectations of the patient because it is determined by the constant, preset curvature of the implant. The incisions in the skin are sewn up and covered with a strip of plaster. The method is not suitable for all patients. If their ears have a large, deep Cavum conchae, which in combination with a poorly formed antihelix is often the cause of a protruding ear, ear pinning in the lower half of the ear is not possible or the ear-pinning result is unsatisfactory. Protruding earlobes can’t be pinned. In comparison to the conventional ear-pinning operations (see traditional ear surgery and otoplasty) and the Stitch method, there are no publications available on long-term results.
EarFold | Surgical Procedure
A scaphocephaly that is diagnosed and treated later in life requires a more extensive secondary operation than one which is treated before five months. A major focus in craniosynostosis reconstruction is maintaining normalized aesthetics of temporal region, and avoiding temporal hollowing. Despite attempts to avoid temporal hollowing by employing overcorrection techniques, autologous fat transfer, and bone grafts, up to 50% of patients still present with depression in the temporal fossa post-operatively.
Craniofacial surgery | Surgical procedures
Following a hemicorporectomy, patients are fitted with a socket-type prosthesis often referred to as a bucket. Early bucket designs often presented significant pressure problems for patients, but new devices have incorporated an inflatable rubber lining composed of air pockets that evenly distributes pressure based on the patient's motions. Two openings at the front of the bucket create space for the colostomy bag and the ileal conduit.
Hemicorporectomy | Prosthesis
Subsequently, all erectile bodies were pushed out and dissected from the penile skin. When available, the foreskin was kept and the distal, coronal edge of the penile skin was closed; this yielded the skin tube that was inserted as neovaginal lining.
Georges Burou | Burou's vaginoplasty procedure
The mouth is developed partly from the stomodeum, and partly from the floor of the anterior portion of the fore-gut. By the growth of the head end of the embryo, and the formation of the cephalic flexure, the pericardial area and the buccopharyngeal membrane come to lie on the ventral surface of the embryo. With the further expansion of the brain, and the forward bulging of the pericardium, the buccopharyngeal membrane is depressed between these two prominences. This depression constitutes the stomodeum.
Stomodeum | Development
The morphology of the stapes suggests that the animal was capable of hearing high-frequency sound. "B. woodi" does not possess lateral line sulci or an ossified branchial system. The principal method of respiration was probably buccal (gulping air through mouth) rather than costal (expanding chest volume to take in air), indicated by the small straight ribs.
Balanerpeton | Introduction
The Cherney incision begins when the skin is cut 2-3 centimeters above the pubic symphysis and the surgeon dissects down to the rectus abdominis muscle. The surgeon then uses blunt dissection with the fingers to separate the tendons from the bladder before cutting the tendons 1-2 centimeters above the pubic symphysis. The muscles are then lifted away, toward the patient's head (cephalad). Then, the peritoneum can be cut and the surgery can proceed.
Cherney incision | Technique
The eyes protrude dorsally and laterally and a lack of hair was seen along the eyes. The postocular lobes were round in shape and not well defined. Adult males have short anal appendages that develop during the final instar phase of development.
Synthemiopsis | Description
The only specimen of "P. primigena" differs from the other species in several ways. The scape is shorter, not extending past the rear margin of the head capsule and the eyes are located closer to the mandibles than in the other species. The estimated body length is approximately with a petiole node that has a triangular outline.
Protopone | "P. primigena"
Surgery is necessary at this point to mechanically mend the bone together.
Scaphoid fracture | Treatment
The development of the vocal sac is different in most species, however they mostly follow the same process. The development of the unilobular vocal sac begins with two small growths on the floor of the mouth. These grow until they form two small pouches, which expand until they meet in the centre of the mouth and form one large cavity, which then grows until it is fully developed.
Vocal sac | Development
The stapedius is the smallest skeletal muscle in the human body. At just over one millimeter in length, its purpose is to stabilize the smallest bone in the body, the stapes.
Stapedius muscle | Introduction
Modern therapy is aimed at surgical reconstruction of the bladder and genitalia. Both males and females are born with this anomaly. Treatment is similar. In males treatments have been: In the modern staged repair of exstrophy (MSRE) the initial step is closure of the abdominal wall, often requiring a pelvic osteotomy. This leaves the patient with penile epispadias and urinary incontinence. At approximately 2–3 years of age the patient then undergoes repair of the epispadias after testosterone stimulation. Finally, bladder neck repair usually occurs around the age of 4–5 years, though this is dependent upon a bladder with adequate capacity and, most importantly, an indication that the child is interested in becoming continent.
Bladder exstrophy | Surgery
Except for the columellar incision, the technical and procedural approaches of open rhinoplasty and of closed rhinoplasty are similar; yet closed rhinoplasty procedure features:
Rhinoplasty | Procedural differences
The opisthotics were thickest at the base and generally similar to those of "Milleretta". They each connected to a thick yet complex stapes which possessed a conspicuous footplate, stapedial foramen, and a dorsal process. A knob on the outer edge of the stapes likely connected to a characteristic spur on the quadrate. What can be seen of the lower jaw indicates that it was primarily formed by the dentary in its front half, and the low, elongated surangular and angular in its rear half. The coronoid had a low peak and the tall articular had a small retroarticular process. Only one tooth was exposed, and it was similar to those of the maxilla, albeit smaller.
Australothyris | Description
Excluding the last flagellomere, all the segments after the scape are as wide or wider than long, while the tip flagellomere is enlarged to equal the lengths of flagellomeres ten to three.
Bradoponera | "B. meieri"
The pterygoids and palatines were seemingly toothless, although this observance may be due to poor preservation. The tip of each ectopterygoid expands into a fan-shaped structure, and the suborbital fenestra is very short.
Prolacertoides | Description
The scapula is ossified from 7 or more centers: one for the body, two for the coracoid process, two for the acromion, one for the vertebral border, and one for the inferior angle. Ossification of the body begins about the second month of fetal life, by an irregular quadrilateral plate of bone forming, immediately behind the glenoid cavity. This plate extends to form the chief part of the bone, the scapular spine growing up from its dorsal surface about the third month. Ossification starts as membranous ossification before birth. After birth, the cartilaginous components would undergo endochondral ossification. The larger part of the scapula undergoes membranous ossification.
Scapula | Development
There are also a medial, postmedial and two crenulate submarginal lines.
Drapetodes croceago | Introduction
The clypeus is setose, meaning that it bears bristles or setae, except on the middle part. The mandibles are small and only contain two teeth. The antennae are moderately long, the scapes are very short but the pedicel is even shorter. The mesosoma measures and is setose. Several setae are seen around the metanotum (the dorsal sclerite) and propodeum. The coxae, the proximal segment and functional base of the leg, are setose (bearing bristle or setae), inflated and large. The metapleural gland opening is small and noticeable, located away from the propodeum and above the metacoxa (the hind of the coxa).
Sphecomyrma | "S. mesaki"
The styloid process arises from endochondral ossification of the cartilage from the second pharyngeal arch.
Temporal styloid process | Development
Since the cavities are exteriorized further inspection and cleaning could be done regularly.(Source:HT, flash007)
Mastoidectomy | Introduction
The short, thickened mandibles have several larger teeth interspersed with small denticles, and are about 50% of the length of the head capsule. The scape is believed to be long and thin, and its mesosoma is narrow and long. The width of the scutum is greater than its length, the legs are noticeably elongated and thin, and the podeum (a narrow stalk that connects the mesosoma with the abdomen) is slightly convex.
Archimyrmex | "A. rostratus"
The template resembling the defect is placed just under the hairline and the vascular pedicle is drawn downwards into the medial eyebrow. The pedicle is based on the supratrochlear vessels and can be 1.2 cm wide. This way the flap design has been made.
Nasal reconstruction using a paramedian forehead flap | Technique
Both the holotype and paratype were recovered from disparate locations, both disarticulated and unassociated. Consequently, spatial relationships are impossible to determine. No record of the original orientation of the material even as recovered, exists. Further material assigned to the taxon has been recovered in isolation with no apparent spatial relationships to each other, and more or less has been referred to "Protoavis" spuriously. Thus, the presentation of the holotype and paratype as coherent skeletons by Chatterjee is fallacious. Such representations are ad hoc conglomerations of bone whose status as conspecific is not apparent from their taphonomy. Not only were the remains recovered disarticulated and unassociated, there are glaring morphometric differences in the various components of the holotype and paratype.
Protoavis | Taphonomy
The largest of the "Cyrtopone" species, "C. striata" has a body length of about and has the biggest difference between head and mesosoma, the head being 2.5 times shorter. The winged gyne is a dorsal impression showing distinct sculpturing on the head and scutum made of longitudinal ridges. The eyes are small, placed near the center of the head, and the gena below them are nearly one and a half times longer than the eye diameter. The scape is longer than in the other species with one third of its length extending past the back margin of the head. The metatibiae shows two spurs, a simple and a pectinate one.
Cyrtopone | "C. striata"
Then the prosthesis was pulled over the bandages and hung over the shoulder by a strap that was attached to the front and back of the funnel to avoid unnecessary pressure on the thigh stump.
Caroline Eichler | Leg prosthesis
Thylakoids and grana arise from the prolamellar bodies during this process.
Etioplast | Introduction
In this single-stage procedure the urethra will be visualized (in the area of the defect), and the incision will be started at its mid-line (usually) using a bovie knife to dissect the dermal and sub-dermal layers until the associated musculature, corpus cavernosum, corpus spongiosum, and ventral urethral aspects are exposed. (a) Particular care is used during the dissection to prevent damage to nerves and blood vessels (which could result in erectile dysfunction or loss of tactile sensation of the penis). The area of the defect is evaluated and marked laterally mid-line, and (marked) positioning sutures are positioned (one, each) at the proximal and distal ends of the area of urethra closest to border of the defective area.
Urethroplasty | Buccal mucosal onlay graft of the ventral urethra
There are two lines of development on behalf of giving a voice to patients being laryngectomized.
Voice prosthesis | History
The term originated with George S. Hackett, MD, in 1956 in a publication titled “The rehabilitation of an incompetent structure by the generation of new cellular tissue”. He applied the term prolotherapy from the words “proli’” (Latin), meaning offspring, and “proliferate”, meaning to produce new cells in rapid succession. Although the erroneous term "sclerotherapy" was utilized by some in the past to describe this treatment, it is now clear that prolotherapy does not cause scarring. The mechanism of prolotherapy requires further clarification. It is expected to involved a number of mechanisms.
Prolotherapy | Terminology
In general terms, the procedure for an open appendectomy is:
Appendectomy | Procedure
This is done by reflecting the mucoperiosteal flap in order to expose the extended bone for complete excision. This bone will then be sent for histopathological examination to differentiate from benign to malignant neoplastic processes. Routine post-operative instructions are given to the patient and occasionally antibiotics may be prescribed. The patient will then be recalled after 1 week in order to remove the sutures and often after a few months for post-operative follow up.
Buccal exostosis | Management
Once the cap is formed, the filamentous cells underneath begin to degrade. The tissue around the edge of the cap grows more quickly. This combination produces a chamber beneath the cap.
Conceptacle | Development