Zur Vertr�glichkeit bioinerter Aluminiumoxidkeramik im Mittelohr

Jahnke, K.; Galić, M.

doi:10.1007/bf00467629

Cited by 8 publications

(5 citation statements)

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“…Yamamoto und Iwanaga stellten ebenfalls eine eigene Serie von Aluminiumoxid-Keramik-Implantaten vor [135]. Bei 150 mit ihrem Implantat operierten Patienten beobachteten Jahnke und Galic [101] zwei Abstoûungen. Auch nach drei-bis 24-monatiger Nachbeobachtung erhöhte sich die Zahl der Abstoûungen nicht [136].…”

Section: Polyäthylenunclassified

“…Die licht-und elektronenoptische Untersuchung zeigte als Fremdkörperreaktion Makrophagen, Riesenzellen und Zelleinlagerungen. ¾hnliche Ergebnisse fanden Jahnke und Galic[101]. Kerr[102] fand bei 52 revidierten Plastipore -Implantaten oberflächlich fibröses Gewebe mit vielen mehrkernigen Fremdkörperriesenzellen und Kunststoffpartikel innerhalb von Granulomen, womit er erstmals den Abbau von Kunststoff im Mittelohr belegte.…”

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Biomaterialien in der rekonstruktiven Mittelohrchirurgie

Dost¹

2000

Laryngorhinootologie

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Biomaterials in Reconstructive Middle Ear Surgergy. Biomaterials are a necessity in modern otosurgery, but none is usefull for all applications. Surface properties, particularly structural characteristics, critically influence the quality of the implantbiological interface. Micropores promote fixation whereas polished surfaces tend to resist it. Prior to the introduction of any new biomaterials, safety precautions must be adhered to rigorously. We showed that osteoblast-like cells grew from human stapedes. This model detected cytotoxicity but it did not show difference in growth when several biomaterials were compared. Hence, animal studies are necessary to evaluate the complicated interactions of mucosa, bone, ventilation and possibly infection with respect to the placement of middle ear prostheses. Nevertheless, animal study results must be interpreted cautiously. In the future therefore, it is clear that rigorously controlled pilot introduction in humans will be required after the biomaterial has passed detailed in-vitro and in-vivo experimental test examinations. The use of plastics often leads to foreign body reaction in the middle ear. Teflon used in stapes prostheses as the only exception, has proved valuable as a result of its low surface energy, and consequently, the avoidance of prosthetic epithelialisation. Most ceramics are biocompatible, but glasses are degradable and therefore of no use in potentially infected ears. Titanium and gold are playing an increasingly important role. However, it should be noted that gold may cause damage to the inner ear, when used as stapes prosthesis. The use of ionomeric cement resulted in fatal complications, when it came in contact with cerebrospinal fluid and consequently, the use of this material has been completely abandoned. S 53 3 Metalle In der Mittelohrchirurgie hat sich inzwischen eine Reihe von Metallen bewährt. In den letzten Jahren haben zusätzlich Gold und Titan eine weitere Verbreitung gefunden. In Bezug auf moderne bildgebende Verfahren ist es wichtig, dass Edelmetalle wie Gold und Titan, und der in Deutschland für Stapesprothesen verwendete Edelstahl eine derart geringe Magnetisierbarkeit aufweisen, dass keine Gefahr für das Innenohr bei Kernspintomographien anzunehmen ist [14]. 3.1 Stahl Stahl ist durch Verbrennung im Hochofen veredeltes Eisen. Hierbei werden Silizium, Mangan, Phosphor, Schwefel und Kohlensäure verbrannt, und aus dem spröden Eisen entsteht ein walz-und schmiedbarer Stahl. Tab. 1 Anforderungen an Biomaterialien für Rekonstruktionen im Mittelohr (nach Jahnke et al. [10]) Biokompatibilität hohe Oberflächenenergie (Ausnahmen: Piston der Stapesprothese, Paukenröhrchen) hohe Stabilität gegenüber körpereigenen Abbauvorgängen und Infektionen hohe mechanische Steifigkeit geringes Gewicht keine Knochenaposition (Ausnahmen: Mastoidobliteration, Rekonstruktion der Gehörgangswand, Fixation von Implantaten auf der Steigbügelfuûplatte) funktionsangepasstes Design leichte intraoperative Bearbeitbarkeit oder problemlose Lagerung unterschiedlicher Impla...

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Section: Polyäthylenunclassified

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Biomaterialien in der rekonstruktiven Mittelohrchirurgie

Dost¹

2000

Laryngorhinootologie

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“…This finding is an important criterion for evaluating the middle ear compatibility of a particular material [4,26]. After initial thickening and poor differentiation, tissue resemblance to normal middle ear mucosa continued to increase with the duration of the experiment, as shown by implant fixation to the tympanic membrane via collagen fibrils.…”

Section: Implants Hardened For 24 Hmentioning

confidence: 99%

“…Moretz et al [33], for example, passed a wire attached to the shaft end of a prosthesis through a footplate. Jahnke and Galic [26] ensured shaft stabilization of aluminum oxide columellae by placing connective tissue discs on the footplate, thus achieving articulation between the shaft and the footplate. Clinically, columellar shafts have not yet been anchored to the footplate with ionomeric cement.…”

Section: Implants Hardened For 24 H and Fixed To The Footplate With Fmentioning

confidence: 99%

“…A material intended for use as a bone substitute in the middle ear must be pre-tested in the middle ear spaces [26] because the risk of occasional bacterial contamination or infection may compromise the biostability of the particular material [20]. In this context, the middle ears of rats [5], rabbits [15,37] and pigs [54] have proved to be suitable experimental models.…”

Section: Introductionmentioning

confidence: 99%

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Ionomeric cement implants in the middle ear of the baboon (Papio ursinus) as a primate model

Städtgen

Schwager

et al. 1998

European Archives of Oto-Rhino-Laryngology

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Faced with an inadequate supply of autogenous materials, the otologic surgeon may have to utilize various alloplastic materials to reconstruct bony middle ear structures. Allogenic materials have fallen into disfavor clinically because of the possible spread of infections. Implantation of the hybrid bone substitute ionomeric cement in viscous or hardened physical states into the middle ears of a primate animal model was undertaken in order to be able to approximate as closely as possible conditions found clinically. The posterior meatal wall was replaced by freshly mixed ionomeric cement in nine baboons (Papio ursinus). After repositioning the meatal flap, the residual skin defect was left to secondary epithelialization. After removal of the stapes superstructure, incus and malleus head, a columella of hardened ionomeric cement was trimmed to the appropriate size and inserted between the footplate and the malleus handle. In three cases the prosthesis shaft was fixed in position with freshly mixed cement near the footplate. The time of follow-up ranged from 47 to 277 days. Gross sections were obtained without decalcification (using a Zeiss saw microtome) and stained with Giemsa solution. In no instance was there any spontaneous epithelialization of the external meatus, although occasional granulation was seen to develop at the free edge of the flap and subepithelially. Epithelialization of the alloplastic columellae occurred as early as 42 days post-implantation. Over the middle ears reconstructed with the viscous cement, there was growth of a thickened epithelium that partially tended to granulate. On light microscopy, the bony footplate area was found to be unaffected by the cement that had been applied when still fluid. Our findings indicate that reconstruction of the posterior meatal wall with the viscous ionomeric cement can be useful clinically. The material does not become dislocated but, as with all other alloplastic materials, spontaneous overgrowth of the adjacent meatal skin is unlikely to occur. The early epithelialization of the columellae and their middle ear compatibility and biostability give support to the excellent tolerability of the ionomeric cement. At present, complications occurring during otoneurological application of the material necessitated its commercial withdrawal from the market in May 1995.

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Implantate in der Mittelohrchirurgie

1992

Teil I: Referate

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Zur Vertr�glichkeit bioinerter Aluminiumoxidkeramik im Mittelohr

Cited by 8 publications

References 0 publications

Biomaterialien in der rekonstruktiven Mittelohrchirurgie

Biomaterialien in der rekonstruktiven Mittelohrchirurgie

Ionomeric cement implants in the middle ear of the baboon (Papio ursinus) as a primate model

Implantate in der Mittelohrchirurgie

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