Ossiculoplasty: autogenous bone grafts, 34 years experience

Abstract

A series of 785 bone grafts between the tympanic membrane and head of the stapes were performed between 1964 and 1998. Ears were divided into 'normal tympanic membrane', 'stage I' and 'stage II' groups, in which the averages of the last postoperative air-bone gaps were 13.2, 18.7 and 18.1 dB, respectively (revision operations included). In the same order 43%, 26% and 23% of the ears showed air-bone gaps equal to or smaller than 10 dB; 85%, 61% and 67% equal to or smaller than 20 dB. Failures specific to the bone columella necessitated nine revision operations (eight for osseous fixation and one for atrophy). There have been no extrusions so far. Although, in the light of the literature the results are acceptable there is room for improvement.

Comparative study of new autologous material, bone‐cartilage composite graft, for ossiculoplasty with Polycel® and Titanium

“…Autologous ossicular graft (incus) was first used for ossicular reconstruction by Hall and Rytzner in 1957 . Luetje et al introduced cartilage ossiculoplasty in 1987 for atelectatic retraction problems .…”

“…Several articles directly compare the postoperative hearing results of different materials for ossicular reconstruction. Woods et al reported that the postoperative mean air‐bone gap was significantly lower in an incus reconstruction group than in the titanium PORP and TORP groups . Mahanty et al also showed that autologous incus gave the best postoperative hearing gains and had the lowest extrusion rate among several ossiculoplasty materials.…”

“…Autologous ossicular graft (incus) was first used for ossicular reconstruction by Hall and Rytzner in 1957. 3 Luetje et al introduced cartilage ossiculoplasty in 1987 for atelectatic retraction problems. 4 Among materials used for reconstruction of ossicular chains, autologous ossicle, cartilage and cortical bone from the mastoid has high biocompatibility, is readily available, has an easily adaptable shape, and has a low extrusion rate.…”

Use of endoscope as adjunct to microscope in cholesteatoma surgery- A non-randomized, non-controlled study

“…This technique provides good surgical exposure for cholesteatoma removal and yields significantly lower rate of residual cholesteatoma than canal wall up procedure, although canal wall up procedure has lower morbidity and better functional outcome [1,2].…”

Necrosis of the long process of the incus following stapes surgery: New anatomical observations

“…A relevant and interesting clinical observation is that the incus deprived of its blood supply can be used as an ossicular replacement prosthesis immediately, or even a year later in staged tympanoplasties, with excellent long‐term results 14. Moreover, cortical bone columella was utilized for ossicular chain reconstruction for a period of 34 years, and necrosis was experienced in only one case 15. Relatively frequent necrosis of the distal end of the long process of the incus might be anticipated after disarticulation of the incudostapedial joint, due to damage to the vessels coming along the stapedius tendon, but this is not observed clinically 16–18…”