Bone cement for ossicular rebridging after otic capsule sparing fracture
23 April 2019 (online)
Ossicular discontinuity can occur in relation with temporal bone fractures and manifests with conductive hearing loss. The purpose of this study is to present hydroxyapatite bone cement rebridging after an atypical otic capsule sparing fracture.
Materials and methods:
A 42-year-old male presented with long standing conductive hearing loss some 3 months after a head injury. The audiogram revealed an air-bone gap of 50 dB on the diseased side. Cone beam computed tomography (CT) detected an atypical fracture of the left temporal bone, communicating with the left external ear canal. The 3D visualization with CT virtual endoscopy suggested injury in the area of the stapes. Intraoperatively, disruption of the incudostapedial joint was discovered without signs of any other trauma to the ossicles. Rebridging with hydroxyapatite based bone cement was undertaken.
No intra-, early or late postoperative complications or side effects were observed. The patient's hearing improved immediately upon removal of the intracanal packing on day 7 after the surgery. One month postoperatively, the air-bone gap decreased to 21 dB. Follow-up CT examination revealed the incudostapedial joint without any signs of dislocation.
Bone cements offer an easy to use approach for ossicular rebridging. They should be available on site to allow another option for tailored surgical approach. Preoperative CT-based virtual endoscopy may suggest the location of the ossicular chain disruption, without being conclusive.