Dataset Information

Long-term follow-up of applying autologous bone grafts for reconstructing tympanomastoid defects in functional cholesteatoma surgery.

ABSTRACT:

Objectives

This study investigated the long-term surgical outcomes of functional cholesteatoma surgery with canal wall reconstruction using autologous bone grafts as the primary material in patients with acquired cholesteatoma.

Subjects and methods

Medical charts were retrospectively reviewed for all patients admitted to one institution for surgical intervention between 2010 and 2018. We analyzed 66 patients (66 ears) who underwent functional tympanomastoidectomy involving the use of autologous bone grafts for canal wall defect reconstruction. Surgical outcomes were evaluated by comparing preoperative audiometric results with follow-up data (at least 36 months after surgery). Logistic regression analyses were performed to determine prognostic factors related to long-term hearing success. These factors included classification and stage of cholesteatoma, stapes condition, ossicular chain damage, active infection of the middle ear, state of the contralateral ear, preoperative hearing thresholds, gender, and age.

Results

The mean follow-up period was 49.2 months. The recidivism rate was 6% (four of 66 ears). The pure-tone average significantly improved from 50.78 ± 19.98 to 40.81 ± 21.22 dB hearing level (HL; p < 0.001). Air-bone gaps significantly improved from 26.26 ± 10.53 to 17.58 ± 8.21 dB HL (p < 0.001). In multivariate logistic regression analysis, early-stage disease (p = 0.021) and pars flaccida cholesteatoma (p = 0.036) exhibited statistically significant correlations with successful hearing preservation.

Conclusion

Functional cholesteatoma surgery with autologous bone grafts reconstruction is an effective approach to significantly improve hearing with low recidivism rates. Localized disease and pars flaccida cholesteatoma were two independent predictors of successful hearing preservation.

SUBMITTER: Lan WC

PROVIDER: S-EPMC8621709 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Long-term follow-up of applying autologous bone grafts for reconstructing tympanomastoid defects in functional cholesteatoma surgery.

Lan Wei-Che WC Wang Ching-Yuan CY Tsai Ming-Hsui MH Lin Chia-Der CD

PeerJ 20211123

<h4>Objectives</h4>This study investigated the long-term surgical outcomes of functional cholesteatoma surgery with canal wall reconstruction using autologous bone grafts as the primary material in patients with acquired cholesteatoma.<h4>Subjects and methods</h4>Medical charts were retrospectively reviewed for all patients admitted to one institution for surgical intervention between 2010 and 2018. We analyzed 66 patients (66 ears) who underwent functional tympanomastoidectomy involving the use ...[more]

PMID: 34900435

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Project description:BackgroundSocket preservation is a proactive approach that limits bone loss after tooth extraction to maintain adequate bone volume, height and width. Many methods have proven effective in achieving socket preservation, including using various bone grafts and autologous platelet concentrates (APCs). Combining these two methods may lead to improved results in socket preservation and patient outcomes.AimsTo compare the combined use of APCs and bone grafts in socket preservation, with the use of bone grafts alone. Primary outcomes were radiographic vertical bone loss (VBL) and horizontal bone loss (HBL).MethodsA search on Pubmed, Scopus, Embase and Google Scholar databases was conducted to identify human studies using APCs in extraction sockets between January 2014 and August 2024. The inclusion criteria involved comparative human studies ranging from evidence levels II to III (Oxford Centre for Evidence-Based Medicine Levels of Evidence). For assessing bias in the included studies, the Cochrane Risk of Bias tools were used. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the quality of evidence available.ResultsA total of five randomised controlled trials (RCTs) were included in the analysis. Studies included the use of platelet rich fibrin (PRF), injectable platelet rich fibrin (i-PRF), advanced platelet rich fibrin (A-PRF), advanced platelet rich fibrin plus (A-PRF+) and concentrated growth factors (CGF). The risk of bias was judged high and moderate for two out of five RCTs. The analysis revealed a combined effect size for VBL reduction, with a standardized mean difference (SMD) of -0.83 (p < 0.001; 95% confidence interval (CI) = [-1.2, -0.57]; I² = 73.13%). For HBL reduction, the combined effect size was SMD = -0.72 (p < 0.001; 95% CI = [-1.08, -0.37]; I² = 68.34%). The overall evidence quality rating for the use of APCs in combination with bone grafts to reduce VBL during socket preservation was assessed as moderate, whereas to reduce HBL it was determined to be low.ConclusionThe current literature demonstrates the added benefits of APCs combined with bone grafts in alveolar socket preservation compared to bone grafts alone in reducing vertical and horizontal bone loss. However, based on the GRADE assessment, the quality of evidence was judged low-to-moderate. Further randomised clinical studies would increase the certainty of the evidence.

Dataset Information

Long-term follow-up of applying autologous bone grafts for reconstructing tympanomastoid defects in functional cholesteatoma surgery.

Objectives

Subjects and methods

Results

Conclusion

Publications

Long-term follow-up of applying autologous bone grafts for reconstructing tympanomastoid defects in functional cholesteatoma surgery.

Similar Datasets

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