Alloplastic bone cements in otologic surgery: Long-term follow-up and lessons learned

Abstract

Objective

Otolaryngologists are often confronted with structural defects in the tegmen, scutum, or external auditory canal . Carbonated calcium phosphate (CCP) bone cements offer an alternative way of managing these defects.

Study Design and Setting

Retrospective review in an academic otology practice. The technical feasibility of these techniques described as well as the wound healing and structural integrity results.

Results

CCP bone cement was used to reconstruct defects of the tegmen or EAC in 22 patients. The material was used to repair the EAC in 19 of these patients, including complete EAC reconstruction in 4 patients, and tegmen defects only in 3 cases.

Conclusion

The surgical technique is not technically difficult and the alloplastic material is hard within minutes of application. Twenty patients have been followed for over 1 year with an average follow-up period of 3.8 years. Failure, defined as infection or explantation, occurred in 4 patients followed over 3 years. There was a difference in outcomes for pediatric cases.

EBM rating: C-4

Get full access to this article

View all access options for this article.

References

Black

Mastoidectomy elimination. Laryngoscope 1995;105:1–30.

Sheehy

JL.

Mastoidectomy: the intact canal wall procedure. Otol Surg 1994;212–24.

Althaus

SR.

Tympanomastoid surgery: a technique for repairing posterior osseous canal wall defects with autologous temporalis fascia and bone pate. Otolaryngol Head Neck Surg 1985;93:227–9.

Shea

Jr Gardner

Jr.

Mastoid obliteration using homograft bone. Arch Otolaryngol 1970;92:358–65.

Wehrs

RE.

Results of reconstructive mastoidectomy with homograft knee cartilage. Laryngoscope 1978;88:1912–7.

Perkins

Tympanomastoid reconstruction, an operative procedure for anatomical and functional restoration of the radicalized ear. Laryngoscope 1976;86:416–30.

Saunders

JE.

External auditory canal reconstruction using resorbable plates. Oral presentation presented at American Academy of Otolaryngology–Head and Neck Surgery, New Orleans, LA; 1999.

Mahoney

JL.

Tympanoacryloplasty. A new mastoid obliteratory procedure: preliminary report. Arch Otolaryngol 1962;75:519–23.

Grote

Kuijpers

The use of biomaterials in reconstructive middle ear surgery. In: Ruben

, ed. Biomaterials in reconstructive surgery. St. Louis: CV Mosby; 1983. p. 987–95.

10.

Hartwein

Hoermann

A technique for the reconstruction of the posterior canal wall and mastoid obliteration in radical cavity surgery. Am J Otol 1990;11:169–73.

11.

Estrem

Highfill

Hydroxyapatite canal wall reconstruction/mastoid obliteration. Otolaryngol Head Neck Surg 1999;120:345–9.

12.

Black

Kelly

Mastoidectomy reconstruction: management of high ridge defects with hydroxylapatite implants. Am J Otol 1994;15:785–92.

13.

Grote

Van Blitterswijk

CA.

Reconstruction of the posterior auditory canal wall with hydroxyapatite prosthesis. Ann Otol Rhinol Laryngol 1986;123:6–9.

14.

Zanetti

Nassif

Antonelli

AR.

Surgical repair of bone defects of the ear canal wall with flexible hydroxylapatite sheets: a pilot study. Otol Neurol 2001;22:745–53.

15.

Grote

JJ.

Reconstruction of the middle ear with hydroxylapatite implants: long-term results. Ann Otol Rhinol Laryngol 1990;99:12–6.

16.

Kveton

Coelho

DH.

Hydroxyapatite cement in temporal bone surgery: a 10-year experience. Laryngoscope 2004;114:33–7.

17.

Babu

Seidman

MD.

Ossicular reconstruction using bone cement. Otol Neurotol 2004;25:98–101.

18.

Mathur

Tatum

Kellman

RM.

Carbonated apatite and hydroxyapatite in craniofacial reconstruction. Arch Facial Plast Surg 2003;5:379–83.

19.

Dornhoffer

Simmons

Canal wall reconstruction with Mimix hydroxyapatite cement: results in an animal model and case study. Laryngoscope 2003;113:2123–8.

20.

Goebel

Jacob

Use of Mimix hydroxyapatite bone cement for difficult ossicular reconstruction. Otolaryngol Head Neck Surg 2005;132:727–34.

21.

Maw

Long term results of mastoid obliteration with bone cements. Abstract for American Otological Society, Nashville, Tennessee; 2003.

22.

Mahendran

Yung

MW.

Mastoid obliteration with hydroxyapatite cement: the Ipswich experience. Otol Neurotol 2004;25:19–21.