What future in the 21st century for tibial bone allografts in ossicular chain reconstruction: the state of the issue.

After using tibial cortical bone allografts in reconstructing the middle ear over a period of ten years, the authors analyze their results. They compare the functional and anatomical outcome at 4 years of 24 patients who received this allografts with a series of 25 patients who underwent incus transposition. Results were analyzed in two different ways: the Air Bone Gap and the Glasgow Benefit Plot. The discussion addresses the techniques used to reduce risks of iatrogenic transmission of viruses and prions, the current legislation in Belgium and the comparative costs, after refunding of the various reconstruction materials. The authors conclude that, because the present-day preparation techniques offer a certain security with regard to transmission risks and because of its numerous advantages (mechanical properties, tolerance, cost and availability), tibial cortical bone still has a promising future.