Titanium Clip Prosthesis

Hüttenbrink, Karl-Bernd; Zahnert, T; Wüstenberg, Eike; Hofmann, G.

doi:10.1097/00129492-200407000-00006

Cited by 58 publications

(46 citation statements)

References 18 publications

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“…Usually, this force is partly borne by the elastic suspension of the (reconstructed) tympanic membrane resulting in effective load forces consistently less than 280mN at the footplate. This is supported by investigations on the titanium clip prosthesis (Hü ttenbrink et al 2004b) at which the prosthesis removal force of 200mN was never exceeded when applying forces equivalent to the mentioned pressure changes.…”

Section: Loading Of the Famentioning

confidence: 67%

“…As mentioned, an accidental stapes extraction was reported to be caused by a bony fixed titanium TORP on the footplate (Sudhoff et al 2005). Temporal bone measurements have yielded a force of approximately 1; 000mN to exceed the strength of the annular ligament and lead to a stapes luxation (Hü ttenbrink et al 2004b). Therefore, the dismountable coupler device of the prosthesis concept requires a self-loosening mechanism, which is activated at forces significantly lower than 1; 000mN .…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of a direct mechanical manipulation on the strut, these forces must be considered as the highest to be tolerated. Investigations on other prostheses like the titanium clip prosthesis (Hü ttenbrink et al 2004b) or the articulated ball joint prosthesis (Beleites et al 2004) showed maximum forces for installation and removal of at most 200mN . Because of anatomical limitations, the angle at which the mounted prosthesis is finally placed is a maximum of 45-out of the strut axis.…”

Section: Loading Of the Famentioning

confidence: 99%

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Osseointegration of Prostheses on the Stapes Footplate: Evaluation of the Biomechanical Feasibility by Using a Finite Element Model

Neudert

Berner

Bornitz

et al. 2007

JARO

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Restoration of hearing is one of the main issues of tympanoplasty. Depending on the extent of destruction, the ossicular chain is partially or totally replaced by prostheses. In the unfavorable event of complete ossicular chain destruction with only the stapes footplate remaining in the oval niche, implanting of a columella prosthesis represents the gold standard. Besides ventilation problems, the main causes of unsatisfactory hearing results are dislocation of the prosthesis and poor coupling to the footplate. Therefore, stable fixation of prostheses is desirable but has not been realized to date. In line with our experimental intention to realize a bony prosthesis fixation on the footplate, we designed a finite element model for the simulation of the interacting forces once an osseointegration was achieved. These preliminary results predict the mechanical feasibility of this endeavor and the necessary general preconditions, which have to be carefully considered. A specially designed titanium prosthesis anchor needs a minimal bony fixation of 104 mm accretion height on the footplate to withstand all emerging forces. Therefore, providing a sort of artificial stapedial suprastructure in the form of a firm, preferably bony, integration of a prosthesis anchor on the footplate seems to be realistic and worthwhile from a mechanical and medical point of view.

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Section: Loading Of the Famentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Loading Of the Famentioning

confidence: 99%

See 1 more Smart Citation

Osseointegration of Prostheses on the Stapes Footplate: Evaluation of the Biomechanical Feasibility by Using a Finite Element Model

Neudert

Berner

Bornitz

et al. 2007

JARO

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“…The new Clip design in titanium PORPs enables easy and secure crimping to the stapes head, thus leading to a more secure assembly with better acoustic transfer [4].…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…Certain conditions, however, mandate a type 3 ossicular reconstruction due to ossicular erosion (resorptive osteitis, cholesteatoma induced) or ossicular disarticulation and removal for epitympanic disease clearance [2]. This can be associated with poorer hearing outcomes due to the primary pathology itself or the less than optimal prosthesis designs, materials and implant extrusions [3,4].…”

Section: Introductionmentioning

confidence: 99%

Cartilage Palisades in Type 3 Tympanoplasty: Functional and Hearing Results

Vashishth

Mathur

Verma

2013

Otolaryngol.--head neck surg.

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To evaluate the functional and hearing outcomes using full thickness broad cartilage palisades for tympanic membrane reconstruction in type 3 tympanoplasty with titanium prostheses. The retrospective study performed at a tertiary referral institute included 30 patients with posterior mesotympanic retraction pockets or tympanic membrane perforations requiring tympanic membrane and type 3 ossicular reconstruction. Patients with disease extending beyond the aditus requiring canal wall down mastoidectomy were excluded. Disease removal from posterior mesotympanic and epitympanic recesses was confirmed using angled endoscopy and ossicular reconstruction was performed using titanium partial or total ossicular replacement prostheses. Tympanic membrane reconstruction was done, with or without attic reconstruction, using full thickness broad cartilage palisades harvested from the tragus with perichondrium attached laterally. Patients were assessed at 24 and 48 weeks for graft status and any evidence of implant extrusion. Hearing evaluation was done using subjective assessment and pure tone audiometry. In total, 27 out of 30 patients had intact and completely healed grafts at 48 weeks postoperatively (a success rate of 90 %) showing full union and epithelialization of palisades, and with three patients displaying small defects. The mean pure tone air bone gap pre-and postoperatively was 32.4 and 8.8 dB, respectively, with most patients reporting satisfactory postoperative hearing. No evidence of implant extrusion was found in the 48-week period. Tympanic membrane reconstruction using full thickness palisades of tragal cartilage provides good functional and hearing outcomes in type 3 tympanoplasty with titanium prostheses.

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Comparison of total and partial ossicular replacement prostheses in patients with an intact stapes suprastructure

Weiss

Großmann

et al. 2019

The Laryngoscope

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Objectives To compare the results of ossiculoplasty with two different partial ossicular replacement prostheses (PORP) to ossiculoplasty with a total ossicular replacement prosthesis (TORP) in patients with an intact stapes suprastructure. Methods All patients required primary or revision surgery for chronic middle ear disease and ossicular reconstruction with either a PORP or a TORP, as well as a with an intact stapes suprastructure. In total, 141 patients receiving classic tympanoplasty with PORP (N = 92), ossiculoplasty with PORP with ball joint (N = 22), or TORP (N = 27) between January 2011 and March 2017 were included in this study. The inclusion criterion was an intact stapes suprastructure. The underlying indication for surgery was either middle ear disease, such as cholesteatoma, or revision surgery for audiological improvement. The main outcome measures were four‐frequency pure tone average (0.5, 1, 2, 3 kHz) at early and late follow‐up after ossiculoplasty, the effects of clinical factors including the underlying middle ear disease, and primary or revision surgery. Results All patients showed a significantly reduced air‐bone gap (ABG 0.5, 1, 2, 3 kHz) at late follow‐up (mean: 18 dB) compared to preoperative measurements (mean: 25.5 dB). A significantly better outcome in ABG closure was shown among patients with a preoperatively intact tympanic membrane, with an intact stapes suprastructure or without preexisting cholesteatoma. Outcome was not significantly influenced by the prosthesis‐type, the creation of an open mastoid cavity, the status of the mucosa, or the indication for surgery. Conclusion TORP with an intact stapes suprastructure is a safe procedure and provides audiological outcomes similar to PORP. Level of Evidence 2C Laryngoscope, 130:768–775, 2020

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Titanium Clip Prosthesis

Cited by 58 publications

References 18 publications

Osseointegration of Prostheses on the Stapes Footplate: Evaluation of the Biomechanical Feasibility by Using a Finite Element Model

Osseointegration of Prostheses on the Stapes Footplate: Evaluation of the Biomechanical Feasibility by Using a Finite Element Model

Cartilage Palisades in Type 3 Tympanoplasty: Functional and Hearing Results

Comparison of total and partial ossicular replacement prostheses in patients with an intact stapes suprastructure

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