Titanium Prosthesis Research Articles

Comparison of Ossiculoplasty Outcomes Using Different Materials in the Treatment of Chronic Otitis Media.

This study aimed to evaluate success rates after ossicular chain reconstruction using different materials. Retrospective cohort study. Tertiary referral center. Four hundred forty-three participants who underwent ossiculoplasty at a tertiary medical center were included. Ossicular chain reconstruction using five materials: autologous malleus, incus, and cortical bone, as well as Hydroxyapatite (HA) and titanium. Hearing data were measured 1 day preoperatively and 6 months postoperatively. Successful hearing outcomes were defined by the fulfillment of more than one of the following criteria: postoperative air-bone gap of 20 dB or less, hearing air conduction (AC) gain of 15 dB or more, or postoperative AC hearing less than 30 dB. Preoperative median AC values (95% confidence interval) among participants with malleus, incus, cortical bone, HA, and titanium transplants or prostheses were 50 (39.6-54.6) dB, 51.3 (48.1-51.8) dB, 50 (45.2-52.2) dB, 56.3 (50.9-57.6) dB, and 54.3 (48.5-56.0) dB, respectively (p = 0.092). The success rates in malleus, incus, cortical bone, HA, and titanium were 53.3%, 60.3%, 51.7%, 61.6%, and 69.7%, respectively. Titanium had the highest success rate among the five materials, but the differences between the materials were not statistically significant (p = 0.283). Titanium had highest success rate among the participants with erosive stapes suprastructure or obstructed Eustachian tubes (p = 0.042 for erosive stapes suprastructure and p = 0.010 for obstructed Eustachian tubes). Our study demonstrated that titanium prostheses would be a good alternative for ossiculoplasty in cases wherein autologous material is unavailable, especially in association with unfavorable conditions, such as with the presence of cholesteatoma, erosive stapes suprastructure, edematous middle ear mucosa, and obstructed Eustachian tube.

Dynamic titanium prosthesis based on 3D-printed replica for chest wall resection and reconstruction.

3D-printing technologies can assist the surgical planning and prosthesis engineering for the management of extended chest wall resection. Different types of prosthesis have been utilized over time, but some concerns remain about their impact on the respiratory function. Here we present a new kind of 3D-printed titanium prosthesis designed to be either strong and flexible. The prosthesis was created on a 1:1 3D-printed anatomic replica of the chest, used to delineate surgical margins and to define the reconstructive requirements.

Experimental and numerical study on warm single-point incremental sheet forming (WSPIF) of titanium alloy Ti–6Al–4V, using cartridge heaters

The single-point incremental forming process is an emerging process, which presents an alternative to the conventional sheet metal forming processes like hydroforming and drawing. It is known to be perfectly suited for prototyping and small series. For example, the incremental forming process offers the possibility of manufacturing medical prosthesis or implants specific to each patient, which are more comfortable and guarantee better performance. The customization of this type of product brings better efficiency and better comfort. However, the manufacture of customized titanium prosthesis is not yet industrialized, mainly due to the geometrical inaccuracy of the parts and inability to form parts with a high wall angle. In fact, considerable forces and damage occur during the process limiting the formability. Several studies have already shown that increasing the working temperature allows improving the formability. A reverse engineering approach associated with warm single-point incremental forming process, in order to produce a customized titanium prosthesis, can make the ability to be exploited in the industry to manufacture titanium alloys medical shapes. In this paper, an experimental and numerical study of the warm incremental process based on the use of heat cartridges is performed. The objective is to demonstrate that our low-cost heating system can be used in forming limit angle similar to that obtained with expensive laser heating. The effects of the wall angle at 450 °C on the forming force, thickness distribution and displacement are investigated by producing a truncated cone with Ti–6Al–4V thin sheets. Results show that the formability is significantly improved with the heating. In addition, a thermo-viscoplastic constitutive model is used to simulate the warm incremental forming process. A comparison of the numerical and experimental results shows that the finite element model gives accurate predictions.

Titanium prostheses versus stapes columella type 3 tympanoplasty: a comparative prospective study

IntroductionTympanoplasty is a surgical procedure designed to reconstruct the mechanisms of sound transmission in the middle ear. ObjectiveAnalyze, from an audiological point of view, patients with chronic otitis media undergoing type 3 tympanoplasty major columella with total ossicular replacement titanium prosthesis or with cartilage graft stapes columella. MethodsThis is a prospective analytical study, carried out at the otorhinolaryngology outpatient clinic in a tertiary care hospital, through the evaluation of 26 patients with chronic otitis media who underwent tympanoplasty using different materials for auditory rehabilitation such as titanium prostheses or cartilage autografts. ResultsThere was no statistically significant association between the group factors (cartilage or titanium reconstruction) and preoperative variables. There was no statistically significant association between the postoperative characteristics of the patients and the type of reconstruction. Neither subjective improvement (hearing improvement) nor residual perforation were associated with a type of material. The via factor was the only one that showed a statistically significant difference once air-conduction pathway improved more than bone-conduction pathway, decreasing the air-bone gap. ConclusionThere was no statistical difference between the two groups in relation to the audiometric improvement. There was hearing improvement in both groups. More studies must be done with a longer follow-up to better evaluate the outcome.

1218 Obstructive Sleep Apnea Due To Oromandibular Dystonia And Treated With Botulinum Toxin

Abstract Introduction Abnormalities of the upper airway are an underrecognized cause of obstructive sleep apnea (OSA). Oromandibular dystonia (OMD) is characterized by involuntary contractions of the masticatory, facial, pharyngeal or laryngeal muscles usually resulting in pain, dysarthria, dysphagia, or impaired mastication. We present a patient with OMD manifest as episodic OSA and sleep maintenance insomnia treated effectively with botulinum toxin injections of the temporalis and masseter muscles. Report of Case A 51-year-old man was referred for fatigue and insomnia. History was notable for prior facial trauma requiring jaw surgeries with titanium prostheses and chronic OMD requiring periodic botulinum toxin injections of the temporalis and masseter muscles. An initial home sleep test (HST) 43 days after the last botulinum toxin injection showed a respiratory event index of 6.5 events/hour. Given severity of symptoms, positive airway pressure (PAP) was initiated; however, due to poor tolerance and persistent symptoms, he was referred for attended polysomnography (PSG). The PSG was done 13 days after an injection and showed apnea-hypopnea index (AHI) of 0 events/hour. Because the patient continued to endorse episodically severe symptoms that he felt paralleled the severity of OMD and waning of botulinum toxin effect, a repeat PSG was performed at a subjective botulinum toxin effect nadir. This PSG done at 83 days post-injection demonstrated AHI of 84 events/hour. PAP therapy was thus resumed, and the patient’s symptoms improved with increased frequency of botulinum toxin treatments. Conclusion To our knowledge, this is the first report of OSA due to chronic dystonia of the facial muscles. Botulinum toxin has demonstrated benefit in the treatment of OMD with efficacy generally lasting three to six months. While PAP remains the first-line treatment for OSA, in patients with structural or functional abnormalities of the upper airway, it is important to also consider treatment of the underlying anatomical defect.

Teflon implants vs titanium implants in stapedotomy - A comparative study

Objective: This study compares two types of implants- a Teflon piston and a titanium piston, used in stapes surgery for otosclerosis. Study Design: A non-randomised prospective study conducted on 40 patients, in 2 groups of 20 each, undergoing stapedotomy in a tertiary care hospital. Pure tone audiometry results were noted preoperatively and 3 weeks post-operatively.Results: Both Teflon and titanium prostheses provided almost equal benefits to patients in terms of Air-Bone gap closure.Conclusion: While there is statistically no significant difference in the results observed, surgical skill of the operating surgeon plays an important role in hearing improvement and long-term results would require long term evaluation.

Effectiveness of Ossiculoplasty with Adjustable Classical Titanium Prostheses and Titanium Prostheses with Porous Hydroxyapatite in Patients with Chronic Otitis Media

Effectiveness of Ossiculoplasty with Adjustable Classical Titanium Prostheses and Titanium Prostheses with Porous Hydroxyapatite in Patients with Chronic Otitis Media

Pediatric ossiculoplasty: optimizing outcomes.

Despite years of research, pediatric ossiculoplasty remains a challenging surgery with numerous variables factoring into successful outcomes. The aim of this review is to summarize recent publications on surgical technique, timing, and reconstruction materials. The cause behind ossicular discontinuity does not seem to play a role in hearing results after ossiculoplasty; however, revision surgery is associated with worsening outcomes. The status of the ossicles remains an active area of interest, but the data remain mixed in terms of them playing a role in predicting outcomes in adults and pediatric patients. There remains debate regarding the utility of staging the reconstruction and is often undertaken on a case-by-case basis. Other recent publications highlight positive outcomes associated with canal wall-up procedures, titanium prostheses, and partial ossicular reconstruction prostheses. Endoscopic middle ear surgery in ossiculoplasty has been shown to be successful in monitoring and removal of disease and helpful in reconstruction. Pediatric ossiculoplasty remains a challenging yet rewarding procedure. The bulk of publications are retrospective making much of the literature difficult to interpret. There remains a need for prospective and well controlled studies in both adult and pediatric populations.

Anatomical and functional rehabilitation after total bilateral maxillectomy using a custom-made bone-anchored titanium prosthesis

Surgical reconstruction after a total maxillectomy remains challenging. The standard treatment is the microvascular free flap. In cases of surgical contraindication, oral rehabilitation is usually performed with a palatal obturator prosthesis (PAP). Acceptable anatomical and functional outcomes in terms of speech, mastication, aesthetic appearance, stability, and comfort are not often achieved with a PAP. This technical note describes a technique for reconstruction after total bilateral maxillectomy involving the implantation of a custom-made bone-anchored titanium prosthesis obtained by 3D printing. Good functional and anatomical outcomes were achieved with this technique. It combines the advantages of the obturator prosthesis (short duration of surgery and hospitalization, low morbidity) and free flap (aesthetic/anatomical reconstruction and irremovable comfortable functional rehabilitation). This technique constitutes a new therapeutic alternative for the restoration of large defects after total maxillectomy when free flaps are contraindicated.

The use of computer-aided design and computer-aided manufacturing fabricated titanium prosthesis to restore maxillofacial defects: 4 cases report

The use of computer-aided design and computer-aided manufacturing fabricated titanium prosthesis to restore maxillofacial defects: 4 cases report

Reconstruction of Bilateral Post-Traumatic Midfacial Defects Assisted by Three-Dimensional Craniomaxillofacial Data in Normal Chinese people—A Preliminary Study

To provide reference data for reconstruction of bilateral midfacial defects for which "mirror technique" cannot be applied. The present study included 4 patients (3 males and 1 female) with post-traumatic bilateral midfacial fractures and defects. The most similar model was retrieved from a database of 552 normal Chinese people and used to guide preoperative virtual surgery planning. All patients underwent open reduction, internal fixation, and reconstruction surgery in 1 stage. A custom-made titanium prosthesis was used to repair the defects of frontal and naso-orbital-ethmoid (NOE) region in 1 patient. Two fibular flaps were used to repair the maxillary defects. A deep circumflex iliac artery flap was used to reconstruct large midfacial defects involving the right zygoma. A surgical navigation system was applied in 3 patients. The 4 patients were followed for 6 to 42months. Two patients had finished all therapies and had satisfactory functional and cosmetic results. The appearance of 1 patient was obviously improved; that patient was still receiving treatment for denture prostheses. One patient had undergone first-stage reconstructive surgery and had normal occlusion at 6months of follow-up. For 3 patients whose treatment had been assisted by navigation, the average surgical deviation was less than 3mm (range, 1.5 to 2.2). For the patient whose treatment had not been assisted with navigation, the deviations differed in different areas: 3.47mm in the right zygomaticomaxillary complex, 5.48mm in the NOE area, and 5.91mm in the maxillary area. For patients with bilateral post-traumatic midfacial defects across the midline, the use of a 3-dimensional craniomaxillofacial database can be considered a feasible method for providing reference data for preoperative planning.

Ameloblastoma affected jaw reconstructed with custom temporomandibular joint titanium prosthesis

Ameloblastoma affected jaw reconstructed with custom temporomandibular joint titanium prosthesis

Immediate mandibular reconstruction with customized titanium prosthesis after ameloblastoma resection - case report

Immediate mandibular reconstruction with customized titanium prosthesis after ameloblastoma resection - case report

Results of Surgical Treatment of Patients with Congenital Auditory Canal Atresia and Microtia

Purpose: Creation and implementation effective methods of complex anatomical, functional and aesthetic rehabilitation for different categories of patients with atresia of the external auditory canal (AEAC) and microtia. Methods: Fourty seven patients (n = 47) with congenital atresia of external auditory canal and microtia of different grade underwent surgery on the base of ear diseases department of Federal Scientific and Clinical Center of Otorhinolaryngology (FSCCO) of Federal Medico-Biological Agency of Russian Federation. All patients were divided into three groups. The first group included patients with EACA and 1 grade microtia. The second group included patients with EACA and 2-3 grade microtia. The third group included patients with AECA and 2-3 grade microtia who underwent different types of surgeries previously, had unsufficient development of local tissue, history of trauma, radiation or auricular cancer. To all of them one of three surgical approaches was performed due to individual features and indications: formation of an EAC, tympanoplasty with ossicular chain reconstruction (n = 23) to the 1st group of patient; formation of an EAC, tympanolasty with ossicular chain reconstruction and concomitant reconstruction of an auricle by use of MEDPORto the 2nd group of patients (n = 9) or fixation of cranial osseointegrated implants (COI) to the 3rd group of patients (n = 15). Results: During the observation period which covered on average 3.2 years (+/- 9 months) achieved stable anatomical result. The air-bone gap was on the average 17,0±3.2 dB. Medpor reconstruction provided reliable aesthetic results. The removable auricural prosthesis completely covered up a congenital defect and was a reflection of a healthy ear. Conclusion: The application of the method of lining the formed bone walls of the external auditory canal with a skin pedicled flapand free skin grafts makes it possible to achieve stable anatomical result. Ossiculoplasty with titanium prostheses and tympanoplasty with auto-fascia graft provide a significant hearing improvement in patients with congenital atresia of the external auditory canal. Simultaneous surgical interventions with atresia repair; tympanoplasty and Medpor implantation or setting of ectoprosthetic on COI can be successfully used to improve hearing, replace abnormal ear in different categories of patients according to indications and return them to the social life.

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses.

(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort. Case series with chart review. Tertiary care center. This study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years. In total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant (P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%). Titanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

Long-Term Audiometric and Clinical Outcomes Following Stapedectomy With the Shape Memory Nitinol Stapes Prosthesis.

To assess long-term hearing outcomes following stapedectomy using a self-crimping shape memory nitinol prosthesis. The results were compared with those of a group of patients who received a conventional prosthesis. Retrospective case review. Tertiary referral center. All patients who underwent stapedectomy for otosclerosis between July 2001 and November 2008 with a minimum dataset of preoperative, early postoperative (≤2 yr), and late postoperative (≥6 yr) audiometry were included. Fifty-six patients with a nitinol prosthesis and 27 patients with a titanium prosthesis met the inclusion criteria. Stapedectomy using a nitinol or conventional prosthesis. Hearing outcomes by audiological assessment. Mean duration of follow up was 9.5 (standard deviation [SD] 1.4) years in the nitinol group and 12.6 (SD 2.1) years in the titanium group. The early and late mean postoperative air-bone gaps (ABGs) were 9.7 and 9.8 dB in the nitinol group and 11.0 and 12.6 dB in the titanium group, respectively. The proportion of patients achieving an ABG less than or equal to 20 dB at early and late follow up was 96% and 96% in the nitinol group and 92% and 86% in the titanium group respectively. The excellent closure of the ABG achieved at early follow up remains remarkably stable up to 12 years using a self-crimping shape memory nitinol prosthesis. There is no evidence that firm fixation of the hook around the long process of incus has a detrimental effect in the long-term.

The benefit of trans-attic endoscopic control of ossicular prosthesis after cholesteatoma surgery.

To show the efficiency of using transmastoid atticotomy (TMA) endoscopy on the outcome of ossiculoplasty in patients with cholesteatoma. TMA is often performed as part of the surgical management of patients with middle ear cholesteatoma extending to the epitympanum. TMA can also be used as an access for endoscopic view to confirm the right alignment and stability of the ossicular prosthesis because the reconstruction of the tympanic membrane will obscure the visualization of the prosthesis. A retrospective study was done at a tertiary referral institute, including 133 ears with cholesteatoma that underwent canal wall-up tympanomastoidectomy (CWU) with ossicular reconstruction using titanium prosthesis between August 2013 and August 2015. Post packing of the ear canal and position, stability, and axis of the prosthesis were checked using endoscope positioned in the attic through TMA. A postoperative pure-tone average air-bone gap (ABG) of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups. Of the 133 ears, 88 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), whereas the rest (45 patients) had total ossicular replacement prosthesis (TORP). A postoperative ABG ≤ 20 dB was obtained in 77.4% of all the patients (79.5% for PORP; 73.3% for TORP). Endoscopic assessment of the ossicular prosthesis via the attic, after repositioning of the tympanomeatal flap and packing the ear canal, decreases the risk of immediate ossiculoplasty failure and improves the functional outcome after ossicular chain reconstruction in cholesteatoma surgery. 4 Laryngoscope, 129:2754-2759, 2019.

Titanyum Protezlerle Yapılan Timpanoplastide Prognostik Faktörlerin Değerlendirilmesi

Aim: This study aimed to assess the effects of preoperatively measured middle ear risk index (MERI) and intraoperative ossicular chain findings on postoperative hearing in patients who underwent ossiculoplasty performed by using universal titanium prostheses.Materials and Methods: Patients who underwent ear surgery using universal titanium prostheses due to malfunctioning in the incus were included. Preoperative ear examination results, surgical findings, and MERI scores were assessed. Preoperative and postoperative air-conduction and bone-conduction hearing thresholds and air-bone gap were assessed at 0.5, 1, 2, and 4 kHz frequencies.Results: We found that presence of the malleus and stapes suprastructure and prognostic MERI grading affected the reconstruction success rate. The air-bone gap results were found to be 100%, 87.5% and 12.5% in the mild, moderate, and severe MERI groups, respectively.Discussion and Conclusion: In line with the literature, we observed that preoperative MERI scoring might help surgeons develop a patient-specific operation strategy by providing guidance during ossiculoplasty

Сравнение аутотрансплантата и титановых протезов в первичной оссикулопластике при выполнении модифицированной радикальной мастоидэктомии

Сравнение аутотрансплантата и титановых протезов в первичной оссикулопластике при выполнении модифицированной радикальной мастоидэктомии

Extensive left chest wall resection with combined plasty of the defect in the patient with chondrosarcoma of the ribs

The objective of the study was to assess the possibility of combined plasty of a chest wall defect in a patient with a massive chondrosarcoma of the chest wall.Material and methods. The restoration of frame-based structures of the chest wall with 4 titanium prosthesis, flap of the left broadest muscle of the back on the stem.Results. Functional indices: the function of external respiration is within normal limits; lung capacity – 96 %; Stange assay – 1 min. 26 sec.; Genci test – 28 sec.Conclusion. The possibility of long-term survival with a good quality of life in a patient with extensive resection of the left half of the chest wall with dimensions up to 420 cm2 is shown.