Bone Pate Research Articles

A Novel Technique of Reduction Meatoplasty for Correction of Very Large Meatus from a Previous Canal Wall-Down Mastoidectomy.

To evaluate the efficacy of reduction meatoplasty, a novel technique aiming to improve the usage of molded hearing aids and ear plugs in patients undergoing mastoid obliteration of a previous canal wall-down (CWD) mastoidectomy, complicated with a very large meatus. Twenty-six patients from a tertiary care neurotology clinic with a very large meatus from a previous CWD mastoidectomy, who were unable to use molded hearing aids or ear plugs for water protection. Reduction meatoplasty after mastoid obliteration (cartilage strips and bone pate) of the CWD mastoidectomy. The procedure involves removing a wedge of skin and underlying soft tissue superiorly in the meatus. Reduction in meatus size, enabling usage of hearing aids and ear plugs. Twenty-six patients underwent mastoid obliteration and reduction meatoplasty to reduce meatus size. Patients were followed up for an average of 22 months postoperation. After operation, the meatus size was significantly reduced in all patients, enabling usage of over-the-counter ear plugs. In addition, all six patients with hearing aids could use standard occlusive hearing aid domes without requiring molded hearing aids. No patients showed symptoms of chronic infection in the mastoid cavity during the follow-up period. Results of reduction meatoplasty showed significant improvements in functionality of the external auditory meatus, indicating that this technique is effective in reducing meatus size and improving the normal meatal anatomy after mastoid obliteration.

Attic reconstruction techniques in cholesteatoma surgery: a comparative analysis of cartilage versus bone pate

Background Cholesteatoma surgery involves canal wall down (CWD) and canal wall up (CWU) mastoidectomy. CWU is associated with higher cholesteatoma recurrence, often linked to attic retraction pockets. Attic reconstruction with cartilage or bone pate lacks comparative evidence. Aims/Objectives To compare the effectiveness of cartilage and bone pate in attic reconstruction during CWU mastoidectomy for cholesteatoma. Material and Methods We conducted a retrospective study at King Abdullah University Hospital (KAUH) in Jordan, analyzing surgeries performed from 2011 to 2021. Patients who underwent CWU mastoidectomy with attic reconstruction using tragal cartilage with perichondrium or bone pate were included. Results Of 48 patients analyzed, 26 had cartilage graft attic reconstruction, and 22 received bone pate. Recurrent cholesteatoma occurred in 19.23% of the cartilage group but none in the bone pate group (p = .001). Ear discharge was observed in 19.23% of the cartilage group and 18.18% of the bone pate group, while tympanic membrane perforations and external auditory canal cholesteatoma were more prevalent in the cartilage group. Conclusions and Significance Our study indicates that bone pate results in significantly lower cholesteatoma recurrence than cartilage grafting in CWU mastoidectomy attic reconstruction. Bone pate offers stability and favorable long-term outcomes for outer attic wall repair.

Cerebrospinal Fluid Otorrhea After a Routine Tympanostomy Tube Placement: A Review of the Literature on Hyrtl Fissure.

To review the literature on Hyrtl fissure (HF) and contribute our experience with a 2-year old who developed cerebrospinal fluid (CSF) otorrhea during routine tympanostomy tube placement. Data Sources: Pubmed and Google Scholar searches were conducted of articles in the English language literature from all time periods using the words Hyrtl, Hyrtl's fissure, HF, and tympanomeningeal fissure. Study Selection: All relevant articles were reviewed to identify cases of HF. Data Extraction: Nineteen cases, including ours, are described. Patient characteristics, method(s) of diagnosis and repair, and outcomes are reported. Computed tomography and intraoperative endoscopic images from our case are included. Presentation is more common in children (66.7% of cases where age was stated, n = 10) than in adults (33.3%, n = 5), and is most commonly unilateral (89.5%, n = 17). Cerebrospinal fluid otorrhea was the most common presentation. Six were discovered after tympanostomy tube placements while 3 were identified during cochlear implant work-up or after device failure. Surgical approaches described include endaural, transcanal, retrosigmoid, postauricular, and posterior fossa endoscopic. Multiple materials including bone wax, bone pate, fascia, muscle, and tissue sealant have been used. Our case describes an endoscopic repair in a child, which was successful at a 2-year follow-up. Data Synthesis: The small number of cases limits the utility of statistical analysis (n = 19). Hyrtl fissure is a rare but important entity that may be discovered when routine procedures have unexpected results. Hyrtl fissure should be included in the differential diagnosis when there is persistent clear otorrhea after a tympanostomy tube, cochlear implant misinsertion, meningitis, or unexplained middle ear effusion in an adult.

Mastoid cavity obliteration in treatment of middle ear cholesteatoma

Objective: The primary goal in the surgical management of chronic otitis media with cholesteatoma is the creation of a dry and safe ear. The method of choice for management of cholesteatoma is the inside out or reverse mastoidectomy. If external auditory canal reconstruction after complete cholesteatoma removal is not possible, mastoid cavity obliteration techniques are recommended to reduce the size of the open mastoid cavity. The goal of our study is to evaluate the frequency of postoperative ear secretion and hearing situation in patients with mastoid cavity obliteration in treatment of middle ear cholesteatoma. Methods: Retrospective study of 155 patients with middle ear cholesteatoma were surgically treatment during 52 months from 01.06.2014 to 30.09.2018 in Hospital Trakia Park, Stara Zagora (Bulgaria) with canal wall reconstruction or mastoid cavity obliteration with cartilage, bone pate or bone replacement alloplastic materials. Results: After complete cholesteatoma removal we perform ear canal reconstruction in 51.61% of cases (80; n=155), and in others 41.94% of cases (65; n=155) we perform mastoid cavity obliteration. In our patient group we perform type I tympanoplasty in 36.77% (57; n=155), type III tympanoplasty in 46.45% (72; n=155), Secondlook operations in 14% (21, n = 155) and only in 5 cases we left the operating cavity open (3.23%; n=155). After mean follow-up period from 11.34 months (1÷48 months; SD 13.10 months) our frequency of postoperative ear secretion is 6.45% (10; n=155) and our cholesteatoma residual rate is 9.03% (14; n=155). Conclusion: Mastoid cavity obliteration procedures can prevent the development of postoperative retraction pockets by isolation the tympanic cavity from the attic and mastoid. This is a safe and effective technique for rehabilitation of mastoid cavities. Hearing results of this technique is variable according to the involvement of the middle ear ossicles, but with the possibility of fitting a hearing aids or middle ear implants.

A Simple Technique to Obliterate Canal Wall Down Mastoid Cavity Concurrently in Squamosal Otitis Media: Our Experience.

Chronic suppurative otitis media is a type of otitis media defined as a long standing infection of a part or whole of the middle ear cleft. Squamosal type of CSOM involves parsflaccida characterised by the formation of cholesteatoma. The present study is retrospective analysis of records of patient who underwent canal wall down mastoidectomy with obliteration of cavity using posteroinferiorly based musculoperiosteal flap with autogenous cartilage and bone pate. Study include patients who underwent canal wall mastoidectomy with cavity obliteration at Tertiary care Hospital Yavatmal, Maharashtra, India; during 2year period of 2016-2018. 41 patients (42 ears) who underwent canal wall down mastoidectomy with cavity obliteration procedure were included and 06 patients were excluded as they failed to follow up. The outcomes were measured by Marchant et al. grading scale. As per the study it was observed that 88% (37 out 42 ears) got adequate control of infection with dry cavity, while 12% (5 ears) failed to attain dry ear. So it's been concluded that canal wall down mastoidectomy is an effective surgical procedure in management of squamosal type of CSOM and mastoid obliteration is proved technique to improve outcomes of canal wall down procedure. Technique used to develop posteroinferiorly based flap to obliterate cavity in our study is simple modification of routine surgical steps commonly practiced by otologist helpful in reducing cavity size and promoting healthy epithelization. Cavity obliteration technique used in study is very effective and simple to develop dry and trouble free cavity in around 90% cases.

Reconstruction of the outer attic wall by cortical bone and bone cement.

To asses using cortical bone and bone pate with and without glass ionomer bone cement (GIBC) for reconstructing the outer attic wall (OAW) defect during cholesteatoma surgery without mastoid cavity obliteration. This is a prospective case series of 25 patients who underwent primary surgery for cholesteatoma with presence of OAW defect that was reconstructed by cortical bone graft and bone pate, further fixation of the cortical bone graft in place was done by GIBC in 18 patients. There was significant improvement of persistent otorrhea and hearing loss after surgery (P<0.001). Recurrence of cholesteatoma was found in 2 patients (8%), residual TM perforation was found in one patient (4%). Reconstruction of OAW by cortical bone and bone pate is an effective surgical option to decrease the incidence of recurrence in cholesteatoma surgery. Glass ionomer bone cement can be added safely to fix the cortical bone graft in the OAW defect.

Comprehensive Treatment of Middle Ear Cholesteatoma

Comprehensive treatment of middle ear cholesteatoma involves preoperative treatment, followed by a radical inside-out aticoanthromastoidectomy with cartilage-perichondrium reconstruction of the tympanic membrane. If possible, a reconstruction of the posterior wall of the external auditory canal is done. In all other cases mastoid obliteration with bone pate, cartilage or artificial bone is performed. In case of intact stapes a type III tympanoplasty is performed; in the absence of stapes suprastructures TORP ossicular chain reconstruction is performed when there are no indications for a second-look surgery. Post-operative follow-up of patients includes regular checkups and DW-MRT in some cases.

Bone Pate Obliteration in Canal Wall Down Mastoidectomy: Modifications of an Established Technique.

To describe outcomes with obliteration of the mastoid and medial attic following canal wall down mastoidectomy for cholesteatoma. Our technique uses bone pate in the mastoid and cartilage in the epitympanum and supratubal recess. Retrospective observational study. Tertiary medical center. Ten years of sequential canal wall down mastoidectomies with obliteration from one neurotologist were reviewed. This included primary and revision cases in adults and children. Complications, location and extent of cholesteatoma, the presence of a dry ear after surgery, cholesteatoma recidivism, revision procedures, and postoperative hearing. Seventy-eight patients (79 ears) met inclusion criteria. There were few major complications. There was active follow-up of a year or more in 61. For these, the mean follow-up was 3.1 years, and approximately 90% had a dry cavity for the remainder of their follow-up. About half required minimal (if any) maintenance. There were five cases with residual disease, and no cases with recurrent disease. There were five cases that were considered failures, with three taking several years to manifest. There were no cases where cholesteatoma was buried in bone pate. A sizeable minority continued to have active tubotympanic disease despite successful treatment of the attic and mastoid. This seems to be a safe and reliable means to eradicate cholesteatoma and create a dry, low-maintenance cavity. It is not a cure for tubotympanic disease, and a small minority of initially stable cavities may fail several years following surgery. 4.

Mastoid Reconstruction With Platelet-Rich Plasma and Bone Pate After Canal Wall Down Mastoidectomy: A Preliminary Report.

Mastoid reconstruction principle had been described to overcome problems of chronic discharging cavity. Different materials were used; nonbiologic materials seem to be less preferred. Platelet-rich plasma (PRP) could promote the regeneration of mineralized tissues. In this work, the authors present a simple and easy technique for mastoid reconstruction with PRP and cortical bone pate. The study design is a case series. Patients had mastoid reconstruction after canal wall down mastoidectomy using PRP and cortical bone pate. This study included 21 patients: 9 males, and 12 females. Sixteen patients had left side disease. All surgical procedures were conducted smoothly within 90 to 135 minutes with no stressful events had been reported. At 12 to 16 months of follow-up, external canal stenosis and mastoid fistulas were not reported. Good healing of the tympanic membrane was seen in 18 patients. No radiological signs suggestive of recurrence were detected and the reconstructed mastoid cavity was smooth and well aerated. Residual tympanic membrane perforations were detected in 3 patients. Autologous materials (PRP and bone pate pate) after canal wall down mastoidectomy appear to be a reliable and effective choice for mastoid reconstruction.

Jugular Bulb Resurfacing With Bone Cement for Patients With High Dehiscent Jugular Bulb and Ipsilateral Pulsatile Tinnitus.

To discuss the possible pathophysiologic mechanism of pulsatile tinnitus (PT) perception due to high jugular bulb with bony dehiscence (HJBD) and its improvement after the dehiscent jugular bulb (JB) resurfacing using bone cement, and to describe the efficacy of an objective measure of PT using transcanal sound recording and spectro-temporal analysis (TSR/STA). Retrospective case series study. A university-based, tertiary care cancer center. Three PT patients with HJBD. All patients underwent transtympanic resurfacing after the source of PT was confirmed by temporal bone imaging and TSR/STA. Improvement of symptom and the changes in the TSR/STA were analyzed. In the first case, a revision operation was performed due to slightly improved but persistent PT after initial resurfacing with bone pate and a piece of conchal cartilage. Revision transtympanic JB resurfacing was performed in this case using bone cement, and PT resolved immediately after the surgery. In the second and third cases, PT resolved completely, or was much abated, immediately after transtympanic resurfacing with bone cement. The TSR/STA also revealed improvement of PT. The median follow-up duration was 28 months, and all three patients remained asymptomatic or much improved compared with their preoperative status. Transtympanic resurfacing with bone cement, reinforcing the dehiscent JB to reduce focal turbulent flow, is a simple and effective surgical treatment option in patients with PT due to HJBD. In patients with HJBD, the objective measurement of PT by TSR/STA may be of help in selecting appropriate surgical candidates and objective evaluation of the treatment outcome.

Mastoid cavity obliteration using bone pate and ribbon-like temporalis muscle flap: Our experience

Objective: The aim of this study was to elucidate a mix of bone pate with ribbon-like temporalis muscle flap for mastoid cavity obliteration after mastoid surgery to avoid mastoid cavity problems. Materials and Methods: In 54 patients of unsafe chronic suppurative otitis media, canal wall down mastoidectomy was done, size of the cavity assessed and ribbon-like temporalis muscle flap with bone pate used for mastoid cavity obliteration. Follow-up was done at 3 weeks, 3 months and then at 6 months. Results: Dry cavity with success rate of 83% is achieved with temporalis muscle flap technique of mastoid cavity obliteration. Conclusion: A mix of bone pate to obliterate the small spaces in the mastoid cavity along with a ribbon-like temporalis muscle flap is effective method of mastoid cavity obliteration as it gives a dry ear, is not bulky and most importantly maintains the canal.

Management of Sigmoid Sinus Associated Pulsatile Tinnitus: A Systematic Review of the Literature.

Although studies demonstrate 4 to 20% of patients with pulsatile tinnitus (PT) have associated sigmoid sinus anomalies, no consensus exists regarding optimal management. Our objective was to perform a systematic review exploring surgical and endovascular intervention of PT caused by sigmoid sinus anomalies. A systematic review was performed using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines for reporting of results, with a target population encompassing patients with PT and either sigmoid sinus diverticulum or sigmoid wall dehiscence. From an initial search yielding 74 articles, 21 manuscripts met inclusion criteria. Of 139 patients, 90.4% were female. Mean age was 39.0 years. Diagnosis was sigmoid sinus diverticulum/aneurysm in 47.5% of patients, sigmoid sinus dehiscence in 35.3% of patients, and both in 17.3%. Sigmoid sinus wall reconstruction/resurfacing (SSW R/R) was used in 91.4% and endovascular procedures in 7.9% of patients. Postoperative recurrence was 3.5% (mean follow-up 21.1 m). Although there was no association between resolution rate and age or sex, right-sided PT resolved at a higher rate. For every increase in body mass index by 1 kg/m, the odds of PT resolution increased 9.2%. PT as a result of sigmoid sinus diverticula, aneurysms, and dehiscence is a rare, but largely treatable condition. Available interventions include SSW R/R, endovascular intervention, and cardiac U-clip techniques. In SSW R/R, bone pate, unspecified soft-tissue graft, and bone cement had the highest rates of PT resolution. While temporalis fascia and autologous bone chips were the materials most commonly used, they had significantly lower rates of PT resolution compared with the other materials, with the exception of auricular cartilage and bone cement. Most episodes of recurrence are resolved with medical management or a revision procedure. This study serves to summarize the current state of knowledge on the treatment of pulsatile tinnitus across disciplines.

The Efficacy of Local Autologous Bone Dust: A Systematic Review

Study DesignA systematic review of bone dust as an autologous bone graft to encourage osseous fusion. ObjectiveTo identify and review studies that report on the therapeutic potential of bone dust. The research question was structured as follows: populations—animal and human sources of bone dust harvested using burrs; interventions—autologous bone dust compared with other clinically utilized bone graft options; outcomes assessed—(1) in vitro cell viability, cell differentiation, and osteogenic potential and (2) clinical efficacy in the form of fusion rates as assessed using plain radiographs; study designs—in vitro, preclinical in vivo and clinical studies investigating the therapeutic potential of bone dust, harvested by burring, are included in this systematic review. Summary of Background DataLittle is known about the efficacy of bone dust, generated during burring of local bone in spine surgery, as a bone graft to encourage osseous union. MethodsA systematic search was conducted in Medline, PubMed, OVID, Scopus, and Cochrane library. The following key words were used: bone dust, bone burring, bone paste, bone pate. ResultsA total of 285 studies were reviewed. Fourteen articles were identified as relevant for inclusion in this systematic review. Current evidence suggests that bone dust retains osteogenic properties, but limited information is available regarding the osteoinductive potential of bone dust. ConclusionBone dust represents a free source of autologous bone, which can be easily collected during the time of surgery and used as an augment to aid osseous fusion. Further research is required to evaluate the osteoinductive potential of bone dust. The retained growth factors in bone dust may potentially induce local osteoprogenitor cells to proliferate and mineralize to form new bone.

Imaging of labyrinthine fistula after repair with bone pate.

To demonstrate imaging of labyrinthine fistula due to cholesteatoma and illustrate outcome following repair with bone pate. Retrospective review. Patients with labyrinthine fistula due to cholesteatoma were identified, and pre- and postoperative imaging was assessed. Method of repair was recorded. The fistula site was examined for patency and bone density after repair. Twenty-nine fistulae were seen in a cohort of 375 cholesteatoma cases (8%). Preoperative computed tomography (CT) imaging for fistula detection showed sensitivity of 96% and specificity of 90%. The lateral semicircular canal was the most common site of dehiscence occurring in all cases. Facial nerve dehiscence is observed in 91% of fistula cases and stapes erosion in 69%. Severe hearing loss was present preoperatively in four (14%) cases. Bone pate was used to repair the fistula with CT-documented restoration of the otic capsule in 11/13 cases with postoperative imaging. When bone pate was not used, the otic capsule defect persisted. Spontaneous repair of the otic capsule following treatment of cholesteatoma is expected to be an uncommon occurrence. Repair of the fistula with bone can result in long-lasting restoration of the otic capsule. 4. Laryngoscope, 128:1643-1648, 2018.

Platelet-Rich Plasma in Reconstruction of Posterior Meatal Wall after Canal Wall Down Mastoidectomy.

Introduction Canal wall down (CWD) mastoidectomy has many drawbacks, including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). Objectives To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using titanium mesh and platelet-rich plasma (PRP) mixed with bone pate. Methods This study was conducted with 20 patients that have atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by titanium mesh and the mixture of PRP with bone pate. All patients were exposed to a full preoperative evaluation and full postoperative assessment of the complications, the appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results The PMW reconstructed by titanium mesh and the mixture of PRP with bone pate showed a smooth contour. During the follow-up of 12 to 36 months, the postoperative appearance of the external auditory canal contour was found to be smooth without hidden pouches, irregularities or stenosis in all cases. No granulation, foreign body reaction, or extrusion and/or displacement of the titanium mesh were registered. No facial palsy or recurrent cholesteatoma was reported. Conclusion The surgical reconstruction of the PMW using PRP, bone pate and titanium mesh after CWD mastoidectomy appears to be reliable without considerable complications, giving a smooth appearance to the PMW.

Cadaveric Study of an Endoscopic Keyhole Middle Fossa Craniotomy Approach to the Superior Semicircular Canal.

Demonstrate that an endoscopic keyhole approach to the middle cranial fossa is technically feasible for repair of semicircular canal dehiscence. Cadaveric technical feasibility/methods development study. Tertiary care military medical center. Three fresh cadaveric heads (six sides). Endoscopic minimally invasive approach to the middle cranial fossa using the Medtronic Fusion Guidance system. Ability to identify the surgical landmarks of the middle cranial fossa and successfully identify and instrument the superior semicircular canal. In every attempt, the arcuate eminence was successfully identified under endoscopic visualization and with the assistance of surgical navigation. The superior semicircular canal was unroofed, and its location confirmed visually and with the navigation system. The opened canal was then plugged with bone wax, bone pate, and covered with fascia. The 15-mm burr hole craniotomy provided ample room for one working instrument and a 4-mm 0-degree endoscope. The endoscopic keyhole approach to superior semicircular canal dehiscence is technically feasible in a human cadaveric model. Further studies will determine 1) if this approach is possible and safe in vivo, 2) is associated with improved surgical outcomes, and 3) if surgical navigation aids in this approach.

Life table analysis of results of staged intact canal cholesteatoma surgery using bone pate to reconstruct the lateral attic wall

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Fascia with Bone Pate Resurfacing Technique in Repairing Superior Semicircular Canal Dehiscence

Objective: To report the surgical, hearing, and balance outcomes following repair of superior semicircular canal dehiscence, implementing a novel technique utilizing fascia, bone pate, and another layer of fascia to resurface the canal dehiscence.

Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus.

Transmastoid sigmoid sinus wall reconstruction is a surgical technique increasingly used for the treatment of pulsatile tinnitus arising from sigmoid sinus wall anomalies. The imaging appearance of the temporal bone following this procedure has not been well-characterized. The purpose of this study was to evaluate the postoperative imaging appearance in a group of patients who underwent this procedure. The medical records of 40 consecutive patients who underwent transmastoid sigmoid sinus wall reconstruction were reviewed. Thirteen of 40 patients underwent postoperative imaging. Nineteen CT and 7 MR imaging examinations were assessed for the characteristics of the materials used for reconstruction, the impact of these on the adjacent sigmoid sinus, and complications. Tinnitus resolved in 38 of 40 patients. Nine patients were imaged postoperatively for suspected complications, including dural sinus thrombosis, facial swelling, and wound drainage. Two patients underwent imaging for persistent tinnitus, and 2, for development of tinnitus on the side contralateral to the side of surgery. The materials used for reconstruction (NeuroAlloderm, HydroSet, bone pate) demonstrated characteristic imaging appearances and could be consistently identified. In 5 of 13 patients, there was extrinsic compression of the sigmoid sinus by graft material. Dural sinus thrombosis occurred in 2 patients. The imaging findings following sigmoid sinus wall repair are characteristic. Graft materials may result in extrinsic compression of the sigmoid sinus, and this finding may be confused with dural venous thrombosis. Awareness of the imaging characteristics of the graft materials used enables this differentiation.

The effects of bone pâté on human osteoblasts cell cultures.

The aim of the present study was to evaluate the effect of bone pate on human osteoblast differentiation by measuring cell viability, alkaline phosphatase activity and expression of the transcription factors and of the major components of the extracellular matrix. Although bone paté has been used in ear surgery for many years and when placed in contact with mastoid and external auditory canal bone become viable, the cellular mechanisms that lead to its osteointegration have never been described. Bone paté taken from four patients subjected to mastoidectomy and affected by middle ear and mastoid cholesteatoma was placed in contact with osteoblast-like cell cultures. Four experimental conditions were obtained: cell cultures treated with bone patè, with bone paté mixed with fibrin glue, with fibrin glue and untreated. After 24h, the viability of the cells was evaluated; after 1week, alkaline phosphatase activity and the expression of transcription factors and bone matrix proteins were assessed by quantitative polymerase chain reaction. After 24h osteoblasts showed increased viability when treated with bone paté (19% increase) and bone pate mixed with fibrin glue (34% increase). After 1week, the number of alkaline phosphatase positive cells increased by 97 and 94% in cultures treated with bone paté alone and bone pate mixed with fibrin glue. Treatment with bone patè upregulated transcription factors and components of the extracellular matrix. The present data show that bone paté has a high osteoinductive potential on human osteoblasts, enhancing their activity.