Promontory drilling with vein graft placement in stapes surgery for cases with narrow oval window niche

Modern surgical management of otosclerosis involves removal of a part of the footplate of the stapes. Stapes surgery in cases of otosclerosis can suddenly become challenging on account of unforeseen anatomical aberrations. Overhang of facial nerve or promontory may compromise the already narrow space making the surgery very difficult or causing inadvertent complications. Drilling the promontory inferiorly and posteriorly may give the surgeon additional space and better anatomical visualisation. This technique along with vein graft placement over the stapedotomy opening has given good consistent results. We report a few cases where this technique was used.