During ossicular reconstruction, the surgeon finds the long process of the incus eroded and the head of the malleus fixed, while the stapes superstructure and footplate are intact and mobile. According to the Wullstein classification, placing the graft directly onto the head of the stapes corresponds to:

• A Type I tympanoplasty
• B Type II tympanoplasty
• C Type IV tympanoplasty
• D Type III tympanoplasty ✓

Explanation

Wullstein Type III (myringostapediopexy) places the graft onto the intact stapes head when the malleus and incus are diseased or absent but the stapes superstructure remains mobile. The stapes acts as a natural columella transmitting sound directly from the graft to the inner ear. In Type II the graft rests on the incus remnant or malleus, and in Type IV the graft covers the round window niche shielding it while exposing the stapes footplate.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.