Complications with hydroxyapatite cement in mastoid cavity obliteration

Abstract

To determine whether hydroxyapatite (HA) bone cement is a suitable material for mastoid cavity obliteration. Retrospective case review; tertiary care pediatric hospital. Three patients, aged 11 to 16 years, underwent canal wall down mastoidectomy for removal of cholesteatomas. Mastoid cavity obliteration was performed with hydroxyapatite bone cement. Failure was defined as the necessity for HA explantation. All three patients required revision surgery to remove the HA cement. Two patients (one primary and one second look with obliteration) presented with granulations in the mastoid cavity, surrounding the cement. The third patient's intraoperative findings included extensive skull base osteitis with erosion of the posterior and middle fossa dural plates, and fistulae of the lateral and superior semicircular canals. All patients recovered fully after removal of the HA cement. This study raises concerns over the use of HA cement for mastoid cavity obliteration. Three of three implanted patients required revision surgery, two with delayed failure of integration and infection, and one with severe osteitis and significant complications.