Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-24T12:30:56.291Z Has data issue: false hasContentIssue false
  • English
  • Français

Performance of ionomeric cement (Ionocem®) in the reconstruction of the posterior meatal wall after curative middle-ear surgery

Published online by Cambridge University Press:  29 June 2007

G. Geyer ,
S. Dazert  and
J. Helms
G. Geyer*
Affiliation:
Department of Otolaryngology, Municipal Hospital Solingen, Germany.
S. Dazert
Affiliation:
Department of Otolaryngology, University of Wuerzburg, Germany.
J. Helms
Affiliation:
Department of Otolaryngology, University of Wuerzburg, Germany.
*
Address for correspondence: Priv.-Doz. Dr G. Geyer, ENT Department, Municipal Hospital, Gotenstr. 1, 42653 Solingen, Germany. Fax: 0212-5472670
Get access Rights & Permissions [Opens in a new window]

Abstract

The hybrid bone-substitute ionomeric cement is suitable for restoring the original anatomy of the posterior canal wall. During a four-year period the posterior meatal wall was rebuilt with ionomeric cement in 74 patients. The canal wall was totally rebuilt in38 patients, two-thirds rebuilt in 22 cases, and one-third rebuilt in14 cases. On the meatal side, the canal wall was covered by a musculo-periosteal (Palva) flap. In the majority of cases, the drum was closed with (cartilage)-perichondrium. Revisions were performed in 27 patients (due partially to cholesteatoma, and/or poor visualization of radical mastoidectomy cavities). The ears were non-infected at thetime of operation.

Permanent epithelialization of the bone replacement material was achieved in 57 cases, with secondary closure of a cutaneous defect of the meatal wall being required in six cases. The auditory canal wall had to be removed in 17 patients owing to deficient soft-tissue coverage, persistent inflammation, and/or partial adhesive processes with development of cholesteatoma. In terms of surgical technique, utilization of the material over a follow-up period of maximally seven years proved it to be a sophisticated procedure for reconstructing themeatal wall. Despite the finesse of the surgical technique employed, the overall failure rate of 31 per cent was inadmissibly high. Implantation of the material should therefore be restricted to middle ears with permanent ventilation and no trace of infection.

Keywords

Ionomeric cementBone cementsMastoid, surgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 111 , Issue 12 , December 1997 , pp. 1130 - 1136
Copyright
Copyright © JLO (1984) Limited 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baier, G., Rosenauer, K., Geyer, G., Helms, J. (1997) Langzeitergebnisse nach Mastoidhöhlenverkleinerung mit Ionomerzement. Poster, 68. Jahresversammlung der Deutschen Gesellschaft fur HNO-Heilkunde, Kopf- und Halschirurgie, Nürnberg, May. HNO 45: 347.Google Scholar
Bellucci, R. J. (1973) Dual classification of tympanoplasty. Laryngoscope 83: 1754–1758.CrossRefGoogle ScholarPubMed
Black, B. (1991) Mastoidectomy reconstruction:use of aluminium templates to shape hydroxyapatite canal wall implants. American Journal of Otology 12: 426–428.Google ScholarPubMed
Borrmann, I. (1996) In-vitro und in-vivo-Untersuchungen zur Belastbarkeit und Haftfähigkeit von Glasionomerzement an Körpergeweben und anderen keramischen alloplastischen Materialien. Inauguraldissertation, Würzburg. (unpublished).Google Scholar
Feldmann, H. (1977) Osteoplastische Meato-Attiko-Antrotomie. Laryngologie Rhinologie 56: 786–795.Google Scholar
Filipo, R., Barbara, M. (1988) Rehabilitation of radical cavities. In Transplants and Implants in Otology. (Babighian, G., Veldman, J. E., eds.), Kugler and Ghedini, Amsterdam, pp 63–67.Google Scholar
Geyer, G. (1992a) Glasionomerzement als Knochenersatzmaterial in der Ohrchirurgie. Babelegi, Pretoria, pp 46–112.Google Scholar
Geyer, G. (1992b) Implantate in der Mittelohrchirurgie. European Archives of Otorhinolaryngology 249 (Suppl I): 185–221.Google Scholar
Geyer, G., Helms, J. (1990) Reconstructive measures in the middle ear and mastoid using a biocompatible cement - preliminary clinical experience. In Advances in Biomaterials Vol 9: Clinical Implant Materials. (Heimke, G., Soltész, U., Lee, A. J. C., eds.), Elsevier, Amsterdam, pp 529–535.Google Scholar
Geyer, G., Helms, J. (1993) Ionomer-based bone substitute in otologic surgery. European Archives of Otorhinolaryngology 250: 253–256.CrossRefGoogle ScholarPubMed
Geyer, G., Helms, J. (1996) Reconstructive surgery. In Head and Neck Surgery, Vol. 2: Ear. (Jahrsdoerfer, J. R. A., Helms, J., eds.), Thieme, Stuttgart, pp 110–129.Google Scholar
Geyer, G., Helms, J. (1997) Ionomerzement als Knochenersatzmaterial in der rekonstruktiven Mittelohrchirurgie. HNO 45: 442–447.CrossRefGoogle Scholar
Geyer, G., Wiedenmann, M., Borrmann, I. (1994) Ionomerzement (Ionocem) als Knochenersatzmaterial in derplastischrekonstruktiven Schädelchirurgie – tierexperimentelle Untersuchungen und klinische Ergebnisse. In Plastischrekonstruktive Maβnahmen bei Knochen- und Weichteildefekten. (Zilch, H., Schumann, E., eds.), Thieme, Stuttgart, pp 156–157.Google Scholar
Grote, J. J. (1990) Reconstruction of the middle ear with hydroxylapatite implants: long-term results. Annals of Otology, Rhinology and Laryngology Suppl 144: 12–16.Google ScholarPubMed
Grote, J. (1996) Der Einsatz von Calciumphosphatkeramik in der rekonstruktiven Chirurgie des Mittelohres und der Schädelbasis. In Chirurgie 1: Knochenersatz in der Mittelohr- und Schädelbasischirurgie. (Hagen, R., Geyer, G., Helms, J., eds.), Sympomed, München, pp 79–80.Google Scholar
Grote, J. J., Lutgert, H. W. (1989) Cavityreconstruction with a hydroxyapatite canal wall prosthesis. In Cholesteatoma and Mastoid Surgery. (Tos, M., Thomsen, J., Peitersen, E., eds.), Kugler and Ghedini, Amsterdam, pp 1013–1018.Google Scholar
Hartwein, J. (1988) Die akustischen Eigenschaften der Radikalhohle (Messungen an einem Modell mit variablem Volumen). Archives of Oto-Rhino-Laryngology Suppl II:Google Scholar
Helms, J. (1996) Surgery of the outer ear, middle ear and temporal bone for the removal of disease and for reconstruction. In Head and Neck Surgery, Vol. 2: Ear. (Jahrsdoerfer, J. R. A., Helms, J., eds.), Thieme,Stuttgart, pp 67–109.Google Scholar
Ionos med Produkte GmbH & Co KG (1995) Fachinformation Knochenersatzmaterial V-O CEM. Seefeld.Google Scholar
Jansen, C. (1985) Intact canal wall for cholesteatoma. American Journal of Otology 6: 3–4.Google ScholarPubMed
Johns, A. N. (1981) The use of Proplast in reconstruction of the posterior meatal wall. Journal of Laryngology and Otology 95: 899–904.CrossRefGoogle ScholarPubMed
Jonck, L. M., Grobbelaar, C. J., Strating, H. (1989a) Biological evaluation of glass-ionomer cement(KETAC-O) as an interface material in total joint replacement. A screening test. Clinical Materials 4: 201–224.CrossRefGoogle Scholar
Jonck, L. M., Grobbelaar, C., Strating, H. (1989b) The biocompatibility of glass-ionomer cement in joint replacement: bulk testing. Clinical Materials 4: 85–107.CrossRefGoogle Scholar
Lenis, A. (1990) Hydroxylapatite canal wall reconstruction in patients with otologic dilemmas. American Journal of Otology 11: 411–414.Google ScholarPubMed
Lübben, B., Geyer, G., Pahnke, J. (1996) Zellkulturversuche zur Toxizität von frisch abgebundenem Ionomer-Zement. Die Wirkung aus aushärtendem Ionomerzement auf 3T3- Mäusefibroblasten. In Chirurgie I: Knochenersatz inder Mittelohr- und Schädelbasischirurgie. (Hagen, R., Geyer, G., Helms, J., eds.), Sympomed, München, pp 155–159.Google Scholar
Plester, D., Hildmann, H., Steinbach, E. (1989) Atlas der Ohrchirurgie. Kohlhammer, Stuttgart, pp 56–57.Google Scholar
Rager, Th. (1996) Vergleichende Untersuchungenzum Verhalten von 3T3-Mäusefibroblasten auf Knochenersatzmaterialien (Polymethylmethacrylat, Aluminiumoxidkeramik, Bioglas, Calciumphosphatkeramik und Ionomerzement). Inauguraldissertation, Würzburg. (unpublished).Google Scholar
Reck, R. (1985) Rekonstruktion der hinteren Gehörgangswand mit Ceravitalprothesen. HNO 33:162–165.Google Scholar
Reck, R., Störkel, S., Meyer, A. (1987) Langzeitergebnisse der Tympanoplastik mit Ceravital-Prothesen im Mittelohr. Laryngo- Rhino- Otologie 66: 373–376.CrossRefGoogle Scholar
Shea, J. J. Jr., Malenbaum, B. T., Moretz, W. H. Jr. (1984) Reconstruction of theposterior canal wall with Proplast. Otolaryngology-Head and Neck Surgery 92: 329–333.CrossRefGoogle Scholar
Städtgen, , Andrea, (1994) Tierexperimentelle Untersuchungen zum Verhalten von Glasionomerzement in der Kopf-Hals- Region - eine histologisch Studie an Pavianen (Papio ursinus). Inauguraldissertation, Würzburg. (unpublished).Google Scholar
Tos, M. (1995) Manual of Middle Ear Surgery. Vol. 2: Mastoid Surgery and Reconstructive Procedures. Thieme, Stuttgart, pp 156–194, 339.Google Scholar
Wiedenmann, R. (1992) Zellmorphologische und quantitative Untersuchungen zum Verhalten von 3T3-Mausefibroblasten und Larynxkarzinomzellen auf Knochenersatzmaterialien - speziell Glasionomerzement. Inauguraldissertation, Würzburg. (unpublished).Google Scholar
Wilson, A. D., McLean, J. W. (1988) Glass-ionomer cement. Quintessence, Chicago, pp 131–199.Google Scholar
Wullstein, H. L., Wullstein, S. R. (1986) Tympanoplastik. Thieme, Stuttgart, pp 62–81.Google Scholar
Zollner, C. H., Strutz, J., Beck, C. H. L., Busing, C. C. M., Jahnke, K., Heimke, G. (1983) Verödung des Warzenfortsatzes mit poroser Trikalziumphosphat-Keramik. Laryngo- Rhino- Otologie 62: 106–111.CrossRefGoogle Scholar