Prefabricated ossicular homografts in middle ear reconstructions

This paper is a review of 132 cases of ossicular reconstruction utilizing prefabricated homografts by clinical staff members of the UCLA Division of Head and Neck Surgery (specializing in ear surgery) in their private practice over the past decade. Another 20 cases completed over the past 2 1/2 years in the UCLA teaching programme are also reviewed. Although ossicular homografts have been used for some time in middle ear reconstruction, this report presents the innovation of prefabricating homografts into specific shapes that lend themselves appropriately to reconstruction problems. In such an ossicular bank, a variety of different shapes, in a number of sizes, is maintained for quick selection. This greatly decreases operating room time and, in addition, provides an effective method for ossicular reconstruction that has already been applied to a resident training programme. The cases in this review can be divided into 3 basic categories: (1) mastoidectomy ossicular reconstruction; (2) exploratory tympanotomy with reconstruction; (3) stapedectomy. This study indicates that ossicular homografts are very well tolerated in their new transplanted positions. Our very low extrusion rate, extremely rare evidence of absorption, and lack of foreign body reaction to these ossicles coincides with the experience of others. This is an advantage over plastic prostheses. In addition to pre- and postoperative air conduction level data, analysis of changes in bone conduction and speech discrimination scores are also presented to evaluate possible neurosensory damage related to manipulation in placing these ossicles.