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RECONSTRUCTION OF OSSICULAR CHAIN: CHALLENGING ISSUE TO OTOLOGISTS

Baglam, Tekin M.D.

doi: 10.1097/MAO.0b013e3181b12101
Letters to the Editor
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Gaziantep University, Faculty of Medicine, Department of Otolaryngology Head and Neck Surgery, Gaziantep, Turkey

To the Editor: I have read with great interest the article entitled, "Partial ossicular reconstruction: comparison of three different prostheses in clinical and experimental studies," by Neudert et al. (1). I congratulate the authors for their valuable contribution to the relevant literature.

In this study, the authors compared 3 different ossicular prostheses in the reconstruction of incudostapedial discontinuity. I think they did a nice job by assessing the results in both clinical and experimental settings.

The authors stated that there are 3 main methods, namely, titanium angle prosthesis, autologous incus interposition, and titanium clip prosthesis available in the reconstruction of destroyed long incus process, which is the most commonly encountered ossicular chain defect. I agree that all 3 are reliable materials used in ossiculoplasty in different clinical situations.

My first choice in the reconstruction of incus long arm defects usually is incudostapedial rebridging ossiculoplasty with bone cement. The authors also discussed ionomeric bone cements in their study and stated that closure of defect by ionomeric cement presents an elegant and easily applicable solution and restores the ossicular chain in the most anatomically and physiologically correct manner. But they discourage the use of bone cements by reminding us tragic complications with ionomeric bone cement. These were cranioplasty cases where ionomeric bone cement was used in large amounts and in direct contact with the cerebrospinal fluid (2,3). The amount of cement used in ossiculoplasty is very small when compared with cranioplasty. There have been no reported cases of toxicity secondary to ionomeric cement ossiculoplasty.

I appreciate their precision about the potential risk of ionomeric bone cements, but there are also hydroxyapatite (HA) bone cements that are nontoxic, are more biocompatible, and have better tissue tolerance than ionomeric bone cements. The main problem with HA bone cements in ossiculoplasty was their prolonged setting time. Recently, HA bone cement with a shorter setting time used in ossiculoplasty was reported (4).

In my experience, as well as that of other authors, bone cements should not be underestimated in ossicular reconstruction because of their ease of application, cost effectiveness, satisfactory hearing results, and tissue tolerance.

Tekin Baglam, M.D.

Gaziantep University

Faculty of Medicine

Department of Otolaryngology Head and Neck Surgery

Gaziantep, Turkey

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REFERENCES

1. Neudert M, Zahnert T, Lasurashvili N, et al. Partial ossicular reconstruction: comparison of three different prostheses in clinical and experimental studies. Otol Neurotol 2009;30:332-8.
2. Renard JL, Felton D, Bequet D. Post otoneurosurgery aluminum encephalopathy. Lancet 1994;344:63-4.
3. Reusche E, Pilz P, Oberasher G, et al. Subacute fatal aluminium encephalopathy after reconstructive otoneurosurgery: a case report. Human Pathol 2001;32:1136-40.
4. Goebel AJ, Jacob A. Use of Mimix hydroxyapatite bone cement for difficult ossicular reconstruction. Otolaryngol Head Neck Surg 2005;132:727-34.
© 2009 Otology & Neurotology, Inc.