PERFORMANCE OF IONOMERIC CEMENT (IONOCEM(R)) IN THE RECONSTRUCTION OFTHE POSTERIOR MEATAL WALL AFTER CURATIVE MIDDLE-EAR SURGERY

The hybrid bone-substitute ionomeric cement is suitable for restoring the original anatomy of the posterior canal wall. During a four-year p eriod the posterior meatal wall was rebuilt with ionomeric cement in 7 4 patients. The canal wall was totally rebuilt in 38 patients, two-thi rds rebuilt in 22 cases, and one-third rebuilt in 14 cases. On the mea tal side, the canal wall was covered by a musculo-periosteal (Palva) f lap. In the majority of cases, the drum was closed with (cartilage)-pe richondrium. Revisions were performed in 27 patients (due partially to cholesteatoma, and/or poor visualization of radical mastoidectomy cav ities). The ears were non-infected at the time of operation. Permanent epithelialization of the bone replacement material was achieved in 57 cases, with secondary closure of a cutaneous defect of the meatal wal l being required in six cases. The auditory canal wall had to be remov ed in 17 patients owing to deficient soft-tissue coverage, persistent inflammation, and/or partial adhesive processes with development of ch olesteatoma. In terms of surgical technique, utilization of the materi al over a follow-up period of maximally seven years proved it to be a sophisticated procedure for reconstructing the meatal wall. Despite th e finesse of the surgical technique employed, the overall failure rate of 31 per cent was inadmissibly high. Implantation of the material sh ould therefore be restricted to middle ears with permanent ventilation and no trace of infection.