hydroxylapatite (ha) columellar prostheses...columellar design. earlier polyethylene designs using a...
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HYDROXYLAPATITE (HA) COLUMELLAR PROSTHESES
© Bruce Black MD
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Columellar design. Earlier polyethylene designs using a flat top were prone to tilting, then pressure, sharp edge, or local
biomaterial effect under the drum, causing extrusion. © Bruce Black MD
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Oval-Top columellar design. The ovoid shape was designed to adapt to a wedge of the pars tensa, overlying the stapes.
© Bruce Black MD
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Oval-Top columella, longitudinal section showing the shape of the head, intended to mimic the drum curvature.
© Bruce Black MD
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Oval-Top TORP design. Effect of prosthetic tilt. The curvature avoided local pressure points.
© Bruce Black MD
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Oval-Top PORP design. Adaptation to longitudinal tilt.
© Bruce Black MD
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Oval-Top PORP. Siting on the intact stapes.
© Bruce Black MD
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Oval-Top TORP. Position on the footplate.
© Bruce Black MD
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Oval-Top PORP and TORP models. The Teflon shafts permitted rapid and simple length adjustment. (Black)
© Bruce Black MD
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Universal application of the Oval-Top design, TORP and PORP models, The shafts were interchangeable under a
common hydroxylapatite head. © Bruce Black MD
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Oval-Top TORP in situ, Rt ear.
© Bruce Black MD
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Oval-Top PORP in situ, RT ear. © Bruce Black MD
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Ova-Top prosthesis evident under the postero-superior pars tensa, Lt ear.
© Bruce Black MD
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Oval-Top PORP after a trans canal ossiculoplasty.
© Bruce Black MD
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Oval-TOP PORP. Case of ICW mastoidectomy for an attic cholesteatoma. A small attic defect has been closed with
autograft cartilage. Grommet in situ (recent OME). © Bruce Black MD
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Oval-Top prosthesis in situ after ICW. Drum repair and extensive attic wall repair with autograft cartilage.
© Bruce Black MD
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Oval-Top ossiculoplasty outcome after a traumatic chain rupture, Lt ear. Lingering anterior dislocation of the malleus
handle evident. © Bruce Black MD
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Oval-Top TORP used in a trans-canal drum and chain repair. Severe adhesive otitis necessitated a total drum
composite graft. © Bruce Black MD
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Radiology showing am Oval-Top TORP under the tympanic membrane. Rt ear. The middle ear is well aerated, without
significant fibrosis. © Bruce Black MD
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Left side Oval-Top Torp. Drum thickened, some middle ear fibrosis.
© Bruce Black MD
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Oval-Top , LT ear, TORP ossiculoplasty. Site free of disease, ear aerated.
© Bruce Black MD
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Oval-Top TORP in a mastoidectomy reconstruction. A hydroxylapatite canal wall prosthesis is seen laterally. The
middle ear shows adhesions but is partially aerated. © Bruce Black MD
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Hybrid hydroxylapatite-titanium columella (Dornhoffer), grooved to permit use as an indirect (L-strut) assembly.
Cartilage overlay prudent if used as a columella. © Bruce Black MD
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Grooved Dornhoffer hydroxylapatite columella/assembly model, adaptable to either PORP or MSA roles.
© Bruce Black MD
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Dornhoffer footplate stabilisation device, designed to prevent footplate “skid” or other displacement of the medial end of the TORP model. The notches adapt to remaining
crural stumps. © Bruce Black MD
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An Oval-Top prosthesis compromised by chronic tubal insufficiency. Severe total drum retraction present, despite Silastic sheeting in the middle ear, visible behind the drum. © Bruce Black MD
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Recurrent cholesteatoma, after an Oval-Top ossiculoplasty. The drum is invaginating between the malleus handle and
the prosthetic head, into the attic. © Bruce Black MD
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Gross pars tensa collapse and extrusion of an Oval-Top TORP. Chronic tubal insufficiency is a major cause of failed
ossiculoplasty. © Bruce Black MD
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Severe drum retraction due to chronic tubal failure, post-ICW surgery. The Oval-Top TORP is draped with fine
squamous epithelium but without rupture. © Bruce Black MD
u
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Drum breakdown due to virulent infection. Oval-Top PORP exposed, later removed.
© Bruce Black MD
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Severe displacement of an Oval-Top PORP. The device has toppled onto its side. The drum remains intact.
© Bruce Black MD
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Marked toppling of an Oval-Top PORP, ICW case complicated by severe tubal insufficiency.
© Bruce Black MD
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Toppled Oval-Top PORP subsequent to a tympanoplasty.
© Bruce Black MD
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Extrusion of an Oval-Top prosthesis. The process is frequently a dry “mummified” occurrence, possibly partially
avascular action. © Bruce Black MD
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Gradual extrusion of a hydroxylapatite head, evidently without infection.
© Bruce Black MD
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Fully extruded Oval-Top TORP, lying in the EAC, 13 years after surgery.
© Bruce Black MD