During tympanoplasty in a patient with an eroded incus but an intact and mobile stapes, the temporalis fascia graft is laid directly onto the head of the stapes. According to the Wullstein classification, this reconstruction corresponds to which type?

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

Explanation

In Wullstein Type III, the graft is placed directly over the stapes head when incus and malleus are deficient but the stapes is intact and mobile, producing a myringostapediopexy or columella effect. Type I is grafting onto a normal ossicular chain with an intact drum, and Type II places the graft onto the malleus handle or incus remnant after partial chain damage. Type IV bypasses the whole chain by grafting onto the promontory to shield the round window.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.