Minoda Ryosei, Hayashida Momoko, Masuda Masako, Yumoto Eiji
Department of Otolaryngology-Head and Neck Surgery, Kumamoto University School of Medicine, Kumamoto, Japan.
Otol Neurotol. 2007 Dec;28(8):1018-21. doi: 10.1097/MAO.0b013e3181557b7c.
To examine the efficacy and safety of mastoid cavity obliteration using highly purified beta-tricalcium phosphate (beta-TCP) after mastoidectomy in middle ear surgery.
Thirteen patients with cholesteatoma invading the mastoid cavity or showing severe pathologic changes in the mastoid cavity.
Twelve patients underwent mastoid obliteration with highly purified beta-TCP during the first- and/or second-stage operation of a 2-stage canal-up operation: 5 patients during the first and second stages, and 7 patients during the second stage only. One patient with cholesteatoma underwent mastoid obliteration with highly purified beta-TCP during a 1-stage canal-up operation. In total, beta-TCP was applied in 18 ear operations.
All patients underwent multislice computed tomography (CT) before and after surgery to assess the condition of the middle ear. The amount of residual beta-TCP granules in the mastoid cavity was assessed using the following granular shadow grading scale: Grade 0, no granular shadow in the mastoid cavity; Grade 1, residual granular shadows in part of the mastoid cavity; and Grade 2, granular shadows in most of the mastoid cavity. To assess any harmful effect of beta-TCP implanted in the mastoid cavity, continuous postoperative discharge and delayed wound healing were recorded. In addition, the bone conduction threshold was assessed using pure-tone audiometry, and the patients were asked whether they experienced vertigo or dizziness during the postoperative follow-up.
All the patients who underwent multislice CT less than 11.4 months after mastoid cavity obliteration with beta-TCP were Grade 2 on the granular shadow grading scale, whereas all those who underwent multislice CT more than 53.8 months after mastoid obliteration were Grade 0. No patient had continuous postoperative discharge, delayed wound healing, or extrusion of beta-TCP granules. No patient showed deterioration of the bone conduction threshold more than 10 dB after mastoid cavity obliteration with highly purified beta-TCP or complained of postoperative vertigo or dizziness.
Highly purified beta-TCP may be safe and reliable for mastoid obliteration. Highly purified beta-TCP may also be useful in other surgical procedures, including posterior wall reconstruction of the external auditory canal and scutum plasty.
探讨在中耳手术乳突切除术后使用高纯度β-磷酸三钙（β-TCP）进行乳突腔填塞的有效性和安全性。
13例胆脂瘤侵犯乳突腔或乳突腔有严重病理改变的患者。
12例患者在两期外耳道上壁手术的第一期和/或第二期手术中使用高纯度β-TCP进行乳突腔填塞：5例在第一期和第二期均进行，7例仅在第二期进行。1例胆脂瘤患者在一期外耳道上壁手术中使用高纯度β-TCP进行乳突腔填塞。总共在18例耳部手术中应用了β-TCP。
所有患者在手术前后均接受多层计算机断层扫描（CT）以评估中耳状况。使用以下颗粒阴影分级量表评估乳突腔内残留β-TCP颗粒的数量：0级，乳突腔内无颗粒阴影；1级，乳突腔部分区域有残留颗粒阴影；2级，乳突腔大部分区域有颗粒阴影。为评估植入乳突腔的β-TCP的任何有害影响，记录术后持续引流和伤口愈合延迟情况。此外，使用纯音听力测定法评估骨导阈值，并询问患者在术后随访期间是否经历过眩晕或头晕。
所有在使用β-TCP进行乳突腔填塞后不到11.4个月接受多层CT检查的患者在颗粒阴影分级量表上为2级，而所有在乳突腔填塞后超过53.8个月接受多层CT检查的患者为0级。没有患者出现术后持续引流、伤口愈合延迟或β-TCP颗粒挤出。在使用高纯度β-TCP进行乳突腔填塞后，没有患者的骨导阈值恶化超过10 dB，也没有患者抱怨术后眩晕或头晕。
高纯度β-TCP用于乳突腔填塞可能是安全可靠的。高纯度β-TCP也可能在其他外科手术中有用，包括外耳道后壁重建和盾板成形术。
