Friedman C D, Costantino P D, Jones K, Chow L C, Pelzer H J, Sisson G A
Section of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, CT 06510.
Arch Otolaryngol Head Neck Surg. 1991 Apr;117(4):385-9. doi: 10.1001/archotol.1991.01870160039005.
Frontal sinus obliteration and reconstruction can be performed with autogenous grafts or synthetic implants, each of which has significant limitations. Hydroxyapatite cement, which can be shaped intraoperatively and sets to a microporous hydroxyapatite implant, was applied to this problem. Nine cats had the anterior table of their frontal sinus unilaterally removed and the sinus cavity stripped of its mucosa. Hydroxyapatite cement was used to obliterate the cavity and reconstruct the overlying anterior table defect. The unoperated side served as the control, and the animals were sacrificed up to 18 months postoperatively. There were no adverse reactions, infections, mucoceles, or implant extrusions. The normal anatomic contour of the forehead region overlying the hydroxyapatite cement implants was maintained in all animals. Histologic examination of undecalcified whole sinus sections revealed progressive replacement of the implants with woven bone without a loss of volume. Replacement of the hydroxyapatite cement by woven bone is postulated to occur through a combination of implant resorption coupled with osteoconduction. The use of hydroxyapatite cement proved successful for the reconstruction and obliteration of cat frontal sinuses, and may be appropriate for the same application in humans.
额窦闭塞和重建可采用自体移植物或合成植入物进行，而这两种方法都有显著局限性。可在术中塑形并凝固成微孔羟基磷灰石植入物的羟基磷灰石水泥被应用于这一问题。9只猫单侧切除额窦前壁，并去除窦腔内的黏膜。使用羟基磷灰石水泥闭塞窦腔并重建覆盖的前壁缺损。未手术侧作为对照，术后长达18个月处死动物。未出现不良反应、感染、黏液囊肿或植入物挤出。所有动物额部覆盖羟基磷灰石水泥植入物区域的正常解剖轮廓均得以保持。对未脱钙的整个鼻窦切片进行组织学检查显示，植入物逐渐被编织骨替代，且体积未减少。推测羟基磷灰石水泥被编织骨替代是通过植入物吸收与骨传导相结合的方式发生的。结果证明，使用羟基磷灰石水泥对猫额窦进行重建和闭塞是成功的，可能适用于人类的相同应用。
