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Obliteration von Mastoidhöhlen

30 Jahre Erfahrung mit Empfehlungen zur Operationsstrategie

Obliteration of mastoid cavities

30 years of experience with recommendations for surgical strategy

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Zusammenfassung

Hintergrund

Die Obliteration von Mastoidhöhlen ist eine geeignete Operation, um die Lebensqualität von Patienten nachhaltig zu verbessern.

Material und Methoden

Nach 30 Jahren wurden aus dem Datenpool von mehr als 16.000 Ohroperationen 843 Fälle analysiert, bei denen eine Mastoidobliteration durchgeführt wurde. Zu den von den Autoren verwendeten Materialien gehörten Knorpel/Knochen, Palva-Lappen, Knochenmehl sowie alloplastisches Material wie Hydroxylapatit (HA) und bioaktives Glasgranulat (BAG S53P4) BonAlive® (Fa. BonAlive Biomaterials Ltd., Turku, Finnland). Als pathologischer Befund wurden Abstoßung mit Entzündung, Granulationen der Gehörgangsrekonstruktion, unübersichtliche Retraktionstaschen sowie Schrumpfung und Narbenzug gezählt. Der Nachuntersuchungszeitraum betrug mindestens 4 Monate bei einem Mittelwert von 33 Monaten (Standardabweichung ±27,8 Monate).

Ergebnisse

Das Material HA wurde nach 18 Fällen nicht mehr eingesetzt, da in 33 % Abstoßungen und Retraktionen auftraten. Dasselbe galt für Knochenmehl nach 33 Fällen mit einem pathologischen Befund von 21 %. Der Palva-Lappen (145 Fälle) wies in 21 % der Fälle einen pathologischen Befund auf, vor allem in Form von Schrumpfung (7 %) und Retraktionen (10 %). Knorpel und Knochenstückchen (516 Fälle) sowie BAG S53P4 (133 Fälle) zeigten nur in 8 bzw. 3 % einen auffälligen postoperativen Befund.

Empfehlenswert ist, bei einer Obliterationsoperation des Mastoids besonderen Wert auf eine Gehörgangs- und Eingangserweiterung zu legen. Bei Verwendung des bioaktiven Glasgranulats ist der Einsatz einer Minidrainage für 1–2 Tage postoperativ von Vorteil, um die Ansammlung von Seromflüssigkeit im Mastoid zu vermeiden.

Schlussfolgerung

Nach den Erfahrungen der Autoren erweist sich eine Kombination von BAG S53P4 und Knorpel als Abdeckung als geeignetes Material zur Höhlenobliteration.

Abstract

Background

The obliteration of mastoid cavities is an appropriate intervention to sustainably improve patients’ quality of life.

Materials and methods

After 30 years, 843 cases of mastoid obliteration were analyzed from the pool of data resulting from 16,000 surgical procedures on the ear. The materials used by the authors included cartilage/bone, Palva flaps, and bone pâté; as well as alloplastic material such as hydroxyapatite (HA) and bioactive glass granules (BAG S53P4) from BonAlive® (BonAlive Biomaterials Ltd., Turku, Finland). Pathological findings included rejection with inflammation, granulation of the auditory canal reconstruction, unclear retraction pockets, as well as shrinkage and cicatricial contraction. The follow-up interval was at least 4 months, with an average of 33 months (standard deviation ± 27.8 months).

Results

Use of HA was discontinued after 18 cases, because rejection and retraction occurred in 33 % of patients. The same applied for bone pâté after 33 cases, with a pathological finding in 21 %. The Palva flaps (145 cases) showed pathological findings in 21  % of cases, primarily in the form of shrinkage (7 %) and retractions (10 %). Cartilage/bone pieces (516 cases) and BAG S53P4 (133 cases) only showed abnormal postoperative findings in 8 % and 3 %, respectively.

It is recommended to focus particularly on auditory canal and canal entrance expansion during mastoid obliteration surgery. When using the bioactive glass granules, postoperative use of a mini-drain for 1–2 days is beneficial, in order to avoid accumulation of seroma fluid in the mastoid.

Conclusion

In our experience, a combination of BAG S53P4 and cartilage as cover is a suitable material for cavity obliteration.

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Literatur

  1. Sade J, Weinberg J, Berco E et al (1982) The marsupialised (radical) mastoid. J Laryngol Otol 96:869–875

    Article  CAS  PubMed  Google Scholar 

  2. Beutner D, Helmstaedter V, Stumpf R et al (2010) Impact of partial mastoid obliteration on caloric vestibular function in canal wall down mastoidectomy. Otol Neurotol 31:1399–1403

    Article  PubMed  Google Scholar 

  3. Kurien G, Greeff K, Gomaa N et al (2013) Mastoidectomy and mastoid obliteration with autologous bone graft: a quality of life study. J Otolaryngol-Head Neck Surg 42:49

    Article  PubMed Central  PubMed  Google Scholar 

  4. Moffat DA, Gray RF, Irving RM (1994) Mastoid obliteration using bone pâté. Clin Otolaryngol 19:149–157

    Article  CAS  PubMed  Google Scholar 

  5. Yung M, Bennett A (2013) Use of mastoid obliteration techniques in cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 21:455–460

    Article  PubMed  Google Scholar 

  6. Reck R (1984) Bioactive glass-ceramics in ear surgery. Animal studies and clinical results. Laryngoscope 94:1–54

    Article  CAS  PubMed  Google Scholar 

  7. Hörmann K (1988) Hydroxyapatite. A new technique for a trouble-free open cavity obliteration with hydroxyapatite tricalcium phosphate and fibrin glue. In: Tos M, Thomsen J, Peitersen E (Hrsg) Transplants and implants in otology. Kugler Ghedini, S 317–321

    Google Scholar 

  8. Hartwein J, Hörmann K (1990) A technique for the reconstruction of posterior canal wall and mastoid obliteration in radical cavity surgery. Am J Otol 11:169–73

    CAS  PubMed  Google Scholar 

  9. Black B (1991) Mastoidectomy reconstruction: use of aluminium templates to shape hydroxylapatite canal wall implants. Am J Otol 12:426–8

    CAS  PubMed  Google Scholar 

  10. Daculsi G, Corlieu P, Bagot D’Arc M et al (1992) Macroporous biphasic calcium phosphate efficiency in mastoid cavity obliteration: experimental and clinical findings. Ann Otol Rhinol Laryngol 101:669–74

    Article  CAS  PubMed  Google Scholar 

  11. Geyer G, Helms J (1993) Inomer-based bone substitute in otologic surgery. Eur Arch Otorhinolaryngol 250:253–6

    Article  CAS  PubMed  Google Scholar 

  12. Estrem SA, Highfill G (1999) Hydroxyapatite canal wall reconstruction/mastoid obliteration. Otolaryngol Head Neck Surg 120:345–9

    Article  CAS  PubMed  Google Scholar 

  13. Clark MPA, Bottrill I (2007) SerenoCemTM-glass ionomeric granules: a 3-year follow-up assessment of their effectiveness in mastoid obliteration. Clin Otolaryngol 32:287–96

    Article  CAS  PubMed  Google Scholar 

  14. Wilson J, Pigott GH, Schoen FJ et al (1981) Toxicology and biocompatibility of bioglass. J Biomed Mater Res 15:805–17

    Article  CAS  PubMed  Google Scholar 

  15. Aitasalo K, Suonpää J, Peltola M et al (1997) Behaviour of bioactive glass (S53P4) in human frontal sinus obliteration. Bioceramics, Oxford Elsevier Science 10:429–432

    Google Scholar 

  16. Peltola M, Suonpää J, Aitasalo K et al (1998) Obliteration of the frontal sinus cavity with bioactive glass. Head Neck 20(4):315–319

    Article  CAS  PubMed  Google Scholar 

  17. Peltola M, Aitasalo K, Suonpää J et al (2006) Bioactive glass S53P4 in frontal sinus obliteration: A long-term clinical experience. Head Neck 28(9):834–841

    Article  PubMed  Google Scholar 

  18. Stoor P, Pulkkinen J, Grénman R (2010) Bioactive glass S53P4 in the filling of cavities in the mastoid cell area in surgery for chronic otitis media. Annals of Otology, Rhinology & Laryngology 119(6):337–82

    Google Scholar 

  19. Silvola JT (2011) Mastoidectomy cavity obliteration with bioactive glass: a pilot study. Otolaryngol Head Neck Surg 145(2):96–7

    Article  Google Scholar 

  20. Sarin J, Grenman R, Aitasalo K et al (2012) Bioactive glass S53P4 in mastoid obliteration surgery for chronic otitis media and cerebrospinal fluid leakage. Annals of Otology, Rhinology & Laryngology 121:563–569

    Article  Google Scholar 

  21. Schimanski G, Schimanski E (2014) Bioaktives Glasgranulat S53P4 zur Obliteration von Mastoidhöhlen. forum HNO 5(16):228–32

    Google Scholar 

  22. Punke C, Goetz W, Just T et al (2012) Mastoidobliteration mit porösem Knochenersatzmaterial (NanoBone®) in Kombination mit Knorpel – Erste Langzeitergebnisse. Laryngorhinootologie 91(9):566–70

    Article  CAS  PubMed  Google Scholar 

  23. Palva T, Palva A, Karja J (1972) Musculoperiosteal flap in cavity obliteration: histopathological study seven years postoperatively. Arch Otolaryngol 95(2):172–7

    Article  CAS  PubMed  Google Scholar 

  24. Minoda R, Hayashida M, Masuda M et al (2007) Preliminary experience with β-tricalcium phosphate for use in mastoid cavity obliteration after mastoidectomy. Otol Neurotol 28:1018–1021

    Article  PubMed  Google Scholar 

  25. Silvola J, Palva T (1999) Pediatric one-stage cholesteatoma surgery: long term results. Int J Pediatr Otorhinolaryngol 49:87–90

    Article  Google Scholar 

  26. Singh V, Atlas M (2007) Obliteration of the persistently discharging mastoid cavity using the middle temporal artery flap. Otolaryngol Head Neck Surg 137:433–438

    Article  PubMed  Google Scholar 

  27. Gray RF, Ray L, McFerran DJ (1999) Further experience with fat graft obliteration of mastoid cavities for cochlear implant. J Laryngol Otol 113:881–84

    Article  CAS  PubMed  Google Scholar 

  28. Vercruysse J-P, De Foer B, Somers T et al (2008) Mastoid and epitympanic bony obliteration in pediatric cholesteatoma. Otol Neurotol 29:953–60

    Article  PubMed  Google Scholar 

  29. Leatherman BD, Dornhoffer JL (2004) The use of demineralized bone matrix for mastoid cavity obliteration. Otology Neurotology 25:22–6

  30. Bagot D’Arc M, Daculsi G (2003) Micro macroporous biphasic ceramics and fibrin sealant as a moldable material for bone reconstruction in chronic otitis media surgery. A 15 years experience. J Mater Sci 14:229–33

  31. Kupperman D, Tange RA (2001) Inomeric cement in the human middle ear cavity: long-term results in 23 cases. Laryngoscope 111(2):306–09

    Article  CAS  PubMed  Google Scholar 

  32. Mahendran S, Yung MW (2004) Mastoid obliteration with hydroxyapatite cement: the Ipswich experience. Otol Neurotol 25:19–21

    Article  CAS  PubMed  Google Scholar 

  33. Stoor P, Söderling E, Salonen JI (1998) Antibacterial effects of bioactive glass paste on oral microorganisms. Acta Odontol Scand 56:161–5

    Article  CAS  PubMed  Google Scholar 

  34. Stoor P, Söderling E, Grénman R (2001) Bioactive glass S54P4 in repair of septal perforations and its interactions with the respiratory infection-associated microorganisms Haemophilus influenzae and Streptococcus pneumonia. J Biomed Mater Res 58:113–20

    Article  CAS  PubMed  Google Scholar 

  35. Stumpf R (2015) Persönliche Mitteilung. HELIOS Klinikum, Aue

    Google Scholar 

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Danksagung

Wir danken Frau Karla Schäfer (Werl) für die unermüdliche Pflege der Datenbank und ihrer Auswertung.

Die pathohistologischen Untersuchungen wurden dankenswerterweise von Dr. med. J. Burg, MVZ Westfalen/Ruhr für Pathologie und Genetik durchgeführt.

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  1. Zentrum für Mittelohrchirurgie, Plastische Nasenchirurgie, Endoskopische Nebenhöhlenchirurgie (FESS), Brechtenerstr. 57, 44536, Lünen, Deutschland

    G. Schimanski & E. Schimanski

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  1. G. Schimanski
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  2. E. Schimanski
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Correspondence to G. Schimanski.

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G. Schimanski und E. Schimanski geben an, dass kein Interessenkonflikt besteht.

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P.K. Plinkert, Heidelberg

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Schimanski, G., Schimanski, E. Obliteration von Mastoidhöhlen. HNO 63, 538–545 (2015). https://doi.org/10.1007/s00106-015-0028-3

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