Histologic Serial Changes of Obliterating Materials in the Rat Temporal Dorsal Bullae / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoid obliteration surgery is a modern trend for otitis media either with or without cholesteatoma. The aim of our study is to evaluate histologic changes and effectiveness over time resulting from different obliterating materials and the existence of mucosa in the temporal dorsal bullae in rats. MATERIALS AND METHOD: Rats were divided into two groups. One group had the mucosa removed and was treated with trichloroacetic acid (TCA). The other group with mucosa remaining was untreated. The temporal dorsal bullae of the two groups of rats were obliterated with Mimix(R) (hydroxyapatite cement), Regenafil(R) (demineralized bone matrix), cartilage chip, and bone chip. Three months and again six months after the implantation, 5 animals in each group were examined. A histological study was performed to evaluate inflammation, new bone formation, and mucocele formation within the bullae. RESULTS: The group that had Mimix(R) implanted had a high inflammatory reaction, low implanted material resorption and cyst formation. The group with Regenafil(R) implanted had high cyst formation and more cyst formation with the passage of time. The group with bone chip implanted had high new bone formation, but also high cyst formation. The group that had cartilage chip implanted had high new bone formation, low implanted material resorption and low cyst formation. CONCLUSION: Cartilage chip is the only material that should be used in the air cell with mucosa remaining. Demineralized bone matrix and bone chip should not be used in the air cell with mucosa remaining. Hydroxyapatite cement should not be used due to severe inflammation.

Histopathologic Study on the Obliteration of the Temporal Dorsal Bullae in Rat Using Hydroxyapatite Cement and Demineralized Bone Matrix / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoid obliteration surgery is a useful technique for otitis media either with or without cholesteatoma. Obliterating materials have to satisfy low antigenecity, less inflammation, little tissue resorption, high regeneration power and good integration into the host tissue. The aim of our study is to evaluate histopathological changes and effectiveness resulting from the different obliterating materials in the temporal dorsal bullae in rats. MATERIALS AND METHOD: We divided the rats into two groups. Group A was untreated, but group B underwent removal of mastoid mucosa with 2% trichloroacetic acid (TCA). Both groups had mastoid obliteration by the implantation of hydroxyapatite cement (Mimix(R)) and demineralized bone matrix (Regenafil(R)). Twelve weeks after the implantation, a histological study was performed to evaluate remaining implanted material, new bone formation and the formation of cysts within the bullae. RESULTS: There was no or minimal inflammation or foreign body reactions in the mastoid obliteration groups with Mimix(R) and Regenafil(R). In the obliterated group that was not treated with 2% TCA, the remaining implanted material with Mimix(R) group was more than in the Regenafil(R) group (p<0.05). The obliterated groups of Mimix(R) and Regenafil(R) were similar with respect to new bone formation. The mucocele formation in the obliterated groups treated with 2% TCA was less than in the obliterated groups not treated with 2% TCA (p<0.05). CONCLUSION: We suggest that Mimix(R) and Regenafil(R) could be valuable resources as graft materials for mastoid obliteration procedures. The research continues for evaluation of long term results of these materials and their potential as graft materials.

A Case of Repair Using Hydroxyapatite Cement for Recurrent Perilymphatic Fistulas Occurred at Round Window After Cholesteatoma Surgery / 대한이비인후과학회지

Perilymphatic fistula (PLF) is a rare condition characterized by abnormal leakage of perilymph from the inner ear into the middle ear via a defect in the oval or round windows. PLF needs special attention concerning early diagnosis and treatment, because it can cause dizziness, hearing loss, tinnitus, meningitis, and other symptoms. The diagnosis of PLF usually cannot be confirmed before exploratory tympanotomy. Fascia, perichondrium, loose areolar tissue, fat and gelfoam can be used effectively in the PLF repair. Fibrin glue was used to aid in securing the graft material. However, recurrence is not rare and revision is sometimes needed to relieve the symptoms associated with the leakage of perilymph. So otologic surgeons should keep in mind that PLF has a great tendency to recur. Careful surgical procedures together with strict postoperative management are important to prevent recurrence and hydroxyapatite cement (HAC) can be used to cover the fistula area as a alternative graft material in recurrent perilymphatic fistula. We report on one recurrent case of postoperative PLF occurring at the round window that was repaired with HAC.

Forehead Reconstruction with Hydroxyapatite Cement(Mimix(TM)) and the Check Framework

PURPOSE: The purpose of this study is to develop hydroxyapatite cement simplified procedures for reconstruction of craniofacial deformities. Due to its expense and characteristics of quick hardening time, it may be inappropriate for forehead reconstruction or augmentation. Therefore we hear by introduce a more precise, easy and cheap method. The authors report forehead reconstruction with hydroxyapatite cement for a patient who suffered from craniofacial deformity. METHODS: Case report and literature review. RESULTS: A 35 year old man came to us with forehead and temporal area depression. He had a history of brain operations due to traumatic epidural hematoma. A physical exam showed an evidence of right side forehead weakness sign. Authors made RP model of his skull and applied check framework with Kirschner's wires for measuring accurate volume and contour on the depressed right side forehead area on the RP model. After complete exposure of defect area by bicoronary insicion, absorbable plate which applied on skull area was removed. Using three Kirschner's wires, authors made check framework on the right forehead lively and fixed with 2-hole miniplates on the boundary of the defect. After checking asymmetry, hydroxyapatite was applied on check shape framework just above Kirschner's wire. After removing Kirschner's wire, we corrected minimal unbalance and contour with bur. CONCLUSION: Check framework with Kirschner's wire was very convenient and cost saving methods for forehead reconstruction with hydroxyapatite cement.

A Case of Congenital Inner Ear Anomaly Combined with Cerebrospinal Leak Using Hydroxyapatite Cement for Treatment / 대한이비인후과학회지

Cerebrospinal fluid otorrhea is a rare disease entity, especially when brought on by spontaneous causes. The site of leakage should be identified to treat the disorder effectively. Various localizing modality was suggested in the literatures. Intrathecal gadolinium-enhanced magnetic resonance imaging identifies the small leakage site easily and correctly. Hydroxyapatite cement is a calcium phosphate-based material that forms dense paste mixed with water or sodium phosphate solution. Hydroxyapatite cement is remarkable for its excellent biocompatability in interacting with the native bone to osseointergrate with the surrounding bone. We report on our experience of successfully treating a patient with the cerebrospinal fluid leak from the congenital inner ear anomaly using the hydroxyapatite cement.

The Various Reconstruction with Hydroxyapatite Powder(Bonesource(R))

Necessity of more biocompatible bone graft material had brought due to the problems of autologous bone graft & synthetic bone substitute materials. Bonesource(R) is a new biomaterial which can be replaced by natural bone when it is implanted. We reviewed our experience with Bonesource(in various reconstruction of bone defect for wide application. From March 2000 to March 2002 at Seoul National University Hospital, we performed various 7 cases of operation with Bonesource(R). These cases were bony depression after mass excision, alveolar cleft, frontal and supraorbital rim fracture, orbital deformity, facial asymmetry, bone defect after cranioplasty, depressive scar. In all cases, results were satisfactory without migration, extrusion, resorption during the follow up period (average 14 months). In 1 case, wound healing was delayed due to redissolution of Bonesource(R) by seroma. This was resolved by drainage without significant loss of volume. Its biocompatibility, excellent bony adhesion(osseointegration) and tendency to be replaced by natural bone(osteoconduction) may make it widely used in plastic surgery. The result of long term follow up and practical technique handling this material effectively are needed to evaluate it further.

Vertebral augmentation for the treatment of vertebral compression fractures subsequent to osteoporosis / 解放军医学杂志

Objective To determine the efficacy of vertebroplasty and kyphoplasty with polymethylmethacrylate (PMMA) and carbonated hydroxyapatite cement (CHC) as augmenting biomaterials in the treatment of osteoporosis vertebral compression fractures subsequent to osteoporosis. Methods 58 patients of osteoporosis with vertebral compression fractures were treated with the following methods: vertebroplasty+PMMA (11 cases, 13 vertebra), vertebroplasty+CHC (23 cases, 26 vertebrae), kyphoplasty+PMMA (8 cases, 8 vertebrae), and kyphoplasty+ CHC (16 cases, 19 vertebrae). The height loss and kyphotic angle of vertebral compression fractures were respectively measured from preoperative and postoperative lateral X-ray films, and with them the restored height ratio and kyphosis angle ratio were calculated. Both preoperation and postoperation pain scores were evaluated by Visual Analog Scale (VAS). Results No complication was found in all the patients. The restored ratio of both vertebra heights and kyphotic angles by kyphoplasty was better than that by vertebroplasty. There was no difference of filling volume in all the groups. The operation time of vertebroplasty was significantly shorter than that of kyphoplasty. There was no difference in preoperative VAS scores. The VAS scores of PMMA groups were better than that of CHC groups, but the difference was not obvious 4 weeks after operation. Conclusion Vertebral augmentation was a minimally invasive, safe and effective method for the treatment of osteoporosis vertebral compression fractures in patients with osteoporosis. The treatment modality and filling biomaterials should be selected according to the patients' condition.