Incus replacement prostheses of hydroxylapatite in middle ear reconstruction

Hydroxylapatite is a calcium bioceramic that has the same chemical composition as living bone, Ca10 (PO4) 6 (OH) 2. Since 1970 it has been used as a material in reconstructive prostheses and augmentation of lost tissues in various surgical specialties including maxillofacial surgery, plastic surgery, otolaryngology, and orthopedics. For over 20 years the author has used autograft and homograft ossicles in tympanoplasty. These incudi have been modified into prostheses that were utilized in ossicular reconstruction. During this time two principle prostheses have evolved, the notched incus with short and long processes. The short process prosthesis is used with an intact stapes, whereas the notched incus with long process carries the sound pressure directly to the stapedial footplate. These prostheses have been successful in improving and maintaining hearing following tympanoplasty. Unfortunately, however, the use of human tissue has certain limitations: it is not readily accessible and has a limited shelf life. Furthermore, clinicians are wary of using homograft tissue as concern over the AIDS virus spreads. Therefore it was felt prudent to develop a manmade prosthesis that would as nearly as possible match the advantages of living bone. Hydroxylapetite most nearly met those qualifications.