A patient with otosclerosis is planned for stapedectomy. Intraoperatively, a persistent stapedial artery is identified crossing the footplate. What is the appropriate management?
- A Coagulate the artery using bipolar diathermy and proceed with stapedectomy
- B Perform a stapedotomy only, leaving the artery intact and threading the prosthesis around it ✓
- C Abandon the procedure and offer a hearing aid instead
- D Carefully divide the artery between ligatures (cauterise, clip and cut) then proceed
Correct answer: B. Perform a stapedotomy only, leaving the artery intact and threading the prosthesis around it
Explanation
A persistent stapedial artery is an anomaly in which the embryonic stapedial artery fails to involute — it passes through the arch of the stapes. If encountered during stapedectomy, the safest approach is to perform a small stapedotomy through the footplate and thread the prosthesis around the artery rather than sacrificing it. Dividing the persistent stapedial artery risks significant bleeding and is not recommended; it may represent the main collateral to the middle meningeal or intracranial circulation.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.