Bernecker F, Hörmann K, Donath K
HNO-Klinik, Klinikum Kaiserslautern.
HNO. 1993 May;41(5):250-3.
The ossicles are often destroyed in patients with chronic otitis media. After removal of inflammatory tissue the surgeon may be confronted with the need to reconstruct the ossicular chain. Apart from homologous ossicles, implants of different materials have been used for this purpose but often without finding the best solution for the problem encountered. As such, we implanted pieces of human dentin and enamel into the middle ears and mandibles of guinea pigs. After staged placements of the grafts in the animal hosts, specimens were removed and prepared for morphological evaluation by embedding in acrylic without prior decalcification. In a mobile unloaded position within the middle ears, implanted specimens were covered by mucosa and showed no evidence for fibrosis or fixation. A joint-like connection to the bony capsule of the middle ear develops as necessary for a type III tympanoplasty. In a mobile, loaded site with contact to bone, implants were surrounded by connective tissue. In connection with the mucosal envelope, this finding confirms the suitability of the materials for ossiculoplasty. When stable within the mandible, implants were surrounded by new bone formation that originated from the host's tissue only, indicating a favorable result for the obliteration of a mastoid cavity. On the surface of both biomaterials, a cell-mediated resorption could be detected, which was more significant in the mandibular site than in the middle ear. However, the long-term biostability of dentin and enamel seems questionable. The synthetic material hydroxyapatite proved less susceptible to biodegradation when tested under identical conditions in a previous experiment.(ABSTRACT TRUNCATED AT 250 WORDS)
在慢性中耳炎患者中,听小骨常遭破坏。去除炎性组织后,外科医生可能面临重建听骨链的需求。除了同种异体听小骨外,不同材料的植入物也已用于此目的,但往往未能找到解决所遇问题的最佳方案。因此,我们将人牙本质和牙釉质块植入豚鼠的中耳和下颌骨。在将移植物分阶段植入动物宿主后,取出标本并通过在不预先脱钙的情况下嵌入丙烯酸树脂来制备用于形态学评估的样本。在中耳内可移动的无负载位置,植入的标本被黏膜覆盖,未显示纤维化或固定的迹象。如III型鼓室成形术所必需的,与中耳骨膜形成了类似关节的连接。在与骨接触的可移动负载部位,植入物被结缔组织包围。结合黏膜包膜,这一发现证实了这些材料用于听骨成形术的适用性。当在下颌骨内稳定时,植入物被仅源自宿主组织的新骨形成所包围,这表明在乳突腔闭塞方面取得了良好结果。在两种生物材料的表面,均可检测到细胞介导的吸收,在下颌部位比在中耳更为明显。然而,牙本质和牙釉质的长期生物稳定性似乎存在疑问。在前一个实验中,在相同条件下测试时,合成材料羟基磷灰石被证明较不易发生生物降解。(摘要截取自250字)