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PubMed1992

Histologic study of the fate of autogenous auricular cartilage grafts in the human temporomandibular joint.

Biopsies of 30 autogenous auricular cartilage grafts previously placed in 21 patients with ankylosis and arthropathy of the temporomandibular joint were studied. These joints were reoperated because of persistent pain and limitation of motion. Histologically, all grafts showed viability of the cartilage. Eighteen cartilage grafts placed after Proplast (Vitek, Inc, Houston, TX) or Silastic (Dow Corning, Midland, MI) implants had been removed, all showed foreign-body granuloma with coexistent intact cartilage grafts. This indicated that the autogenous auricular cartilage was resistant to the foreign-body reaction. All cartilage grafts were encased by fibrous tissue. This overgrowth of fibrous tissue may be responsible for the ankylosis. Seven grafts showed cartilaginous proliferation grossly and all showed proliferation histologically. The cartilage proliferation also may contribute to the persistent symptoms and recurrent limitation of joint motion.

Adult↗
PubMed1999

Medialization laryngoplasty.

Medialization laryngoplasty was performed in 25 patients between 1993 and 1997. The underlying pathology resulting in glottal incompetence was vocal cord paralysis in 22 patients and vocal cord bowing in 3 patients. Two types of implants were used: self-carved Proplast in 19 patients and prefabricated hydroxyapatite prostheses in 6 patients. Preoperative and postoperative results were compared in terms of dysphagia, vocal quality as graded by three experienced voice specialists, and computer measurements of the glottal gap. All patients showed improvement both subjectively and on the objective measurements used. Swallowing returned to normal in all patients who had isolated recurrent laryngeal nerve paralysis. The voice improved in all patients but was rarely judged as entirely normal.

Adult↗
PubMed1980

Obliteration of traumatically induced articular surface defects using a porous implant.

Trauma to articular surfaces penetrating through the subchondral bone can result in areas of incomplete healing. Intraarticular adhesions can originate from these loci of disorganized fibrous bone and cartilage and, along with the incongruous surface, limit motion. In a group of 28 white New Zealand rabbits, 44 standard size defects were created in the prepatellar intercondylar femoral grooves. Twenty-seven were filled with Proplast, a porous implant material. Seventeen were left as controls. The animals were killed at intervals from 3 to 51 weeks. The implant areas were studied grossly and histologically. Granulation outgrowth and adhesions were not seen. From 12 weeks on, normal-appearing hyaline cartilage covered the surface, and bone ingrowth was found within the implant.

Animals↗
PubMed1996

High failure rate of soft-interface stem coating for fixation of femoral endoprostheses.

Twenty-five total hip arthroplasties were performed in 25 patients using a femoral stem with a soft-interface coating of Proplast (Vitek, Houston, TX). Follow-up periods for 24 of the hips ranged from 82 to 104 months (median, 96 months). Fourteen (58%) of the hips were judged to be failures, and nine of the failures were revised. The prostheses were thought to have failed because the coating was not strong enough to withstand normal weight-bearing loads. This inner-substance failure of the coating was seen in all revision operations. During these revisions, parts of the coating remained in the shaft as well as on the prosthesis stem. The combination of clinically manifest midthigh pain and radiologic scalloping and/or the pedestal sign seem to justify a strong suspicion of looseness of this type of cementless femoral endoprosthesis.

Adult↗
PubMed1997

Temporomandibular joint devices: treatment factors and outcomes.

TMJ devices have been used for many years in reconstruction of the temporomandibular joint (TMJ). The most common endosseous implant currently used in TMJ reconstruction is a mini-anchor that is placed in the posterior head of the condyle to support artificial ligaments to stabilize the articular disk in the proper position. A 2-year follow-up study shows a success rate of 90% in reference to incisal opening jaw and occlusal stability, and significant reduction in presurgical pain level. Some materials that have been used in TMJ reconstruction, including Proplast-Teflon (PT) and Silastic devices, have caused devastating problems for patients. These materials, (particularly the PT) can cause severe foreign-body giant-cell reaction, severe bone and soft-tissue destruction, and migration of particles to other body areas, and may initiate or exacerbate connective tissue and autoimmune disease problems. Christensen joint prosthesis has been reported to have very good success in TMJ reconstruction. The most thoroughly studied TMJ total joint device is the Techmedica custom-made total joint prosthesis, with a 5-year follow-up study on 31 patients and 52 reconstructed joints. All patients have functioning prostheses with good jaw and occlusal stability and an average pain reduction of 4.4 points on a 0-to-10 visual analog pain scale. However, this device currently is unavailable. In complex cases requiring multiple TMJ operations, particularly those with previously failed alloplast, a custom-made total joint prosthesis, using materials with proven safety and efficacy in orthopedic joint reconstruction, may be the only option available to improve predictably the quality of life of these patients.

Autoimmune Diseases↗
PubMed1979

Cranioplasty with pre-formed methyl methacrylate onlay plates.

The available manufactured plates for cranioplasty of large skull defects are not always satisfactory. Recently we have used preformed methyl methacrylate plates, in combination with Proplast. This plate prepared adjusted and sterilized before the operation is both cosmetically and mechanically satisfactory.

Adult↗
PubMed1999

Considering total temporomandibular joint replacement.

Patients with very advanced degenerative disease, ankylosis, post-traumatic condylar destruction, and multi-operated patients may be candidates for joint replacement with fossa and condylar prostheses. Great advances have been made in developing biocompatible materials, improved designs for patient-fitted prostheses. These devices have treated internal derangement cases after multiple surgical and nonsurgical treatment failures, as well as restoring form and function following the removal of failed Vitek Proplast-Teflon (Houston, Texas) containing temporomandibular joint implants. This paper will provide practitioners dealing with complex, debilitated, functionless temporomandibular joint (TMJ) patients with information related to this treatment modality. They will then be able to address the indications for the use of alloplastic temporomandibular joint replacement devices, the devices presently available, the surgery involved in their placement, possible complications of implantation and post-operative outcomes and expectations with patients who would benefit from the implantation of these devices.

Arthroplasty, Replacement↗
PubMed1991

Gore-Tex for augmentation of the nasal dorsum: a preliminary report.

Many different materials have been used to provide augmentation of the nasal dorsum. This includes both autogenous and homogenous materials, as well as allografts. Many times autogenous material is not readily available and homogenous materials have recently demonstrated significant absorption. Several artificial materials have been used in the past, including Supramid, silicone, and Proplast, each with its own limitations or problems. Two years ago we began using Gore-Tex Soft Tissue Patch as a material to augment the nasal dorsum. Although our experience is preliminary, certainly, experience with this material in cardiac and abdominal surgery is extensive. Our initial impression is that this material is a very useful alternative to traditional methods of nasal augmentation.

Adolescent↗
PubMed1996

Obliteration of the eustachian tube using hydroxyapatite cement: a permanent technique.

Permanent obliteration of the eustachian tube via the middle ear traditionally has met with limited success. Combinations of muscle, fascia, adipose tissue, bone fragments, and inert material such as Proplast have been used to seal the middle ear from the nasopharynx by inciting a fibrous reaction within the lumen of the eustachian tube. Long-term follow-up has demonstrated repneumatization of the middle ear cleft in the majority of cases, indicating failure of the obliteration technique. This report describes a technique for successful long-term obliteration using hydroxyapatite cement. This new biomaterial possesses osseointegrative and osseoconductive properties that result in permanent obliteration by producing new bone formation within the lumen of the eustachian tube. This technique eliminates the complication of cerebrospinal fluid rhinorrhea in lateral skull base procedures that expose the eustachian tube to cerebrospinal fluid.

Biocompatible Materials↗
PubMed1988

Malar augmentation using autogenous composite conchal cartilage and temporalis fascia.

Prominent malar regions are considered by many in Western society to be a mark of beauty. The increased awareness of this important aesthetic feature has made correction of the poorly defined cheekbone one of the goals of aesthetic surgery of the face. Procedures incorporating alloplastic materials have been described. However, malar implants of this type have not been universally accepted. Silicone gel-filled, silicone rubber, and Proplast implants have enjoyed popularity in facial augmentation. Each of these materials shows low complication rates, but problems related to use are (1) the inevitability of formation of a tissue capsule, which, although responsible for implant stabilization, also may cause deformation of silicone implants, and (2) bacterial contamination at the tissue-implant interface. We propose a new technique of malar augmentation through the use of composite autogenous conchal cartilage grafts and temporalis fascia grafts. A case report and illustrations are presented, including a description of this technique. It is postulated that the use of autogenous materials in malar augmentation can give acceptable results and obviate the inherent risks associated with the use of alloplastic materials.

Cartilage↗
PubMed1989

MR of osteochondritis dissecans and avascular necrosis of the mandibular condyle.

We studied 40 patients exhibiting radiologic changes of either osteochondritis dissecans (OCD) or avascular necrosis (AVN) involving the mandibular condyle to evaluate the structural changes associated with these lesions when using high-field-strength MR imaging. Various clinical indications for imaging each patient with routine radiography, tomography, and surface-coil MR included headache, temporomandibular joint (TMJ) and/or ilsilateral facial pain, joint crepitus, clicking, locking, and either recently acquired or changing (unstable) occlusal disorder. Radiologic findings included alterations in condyle morphology and MR signal characteristics compatible with either OCD or AVN or, in some cases, both. Previous nonsurgical mandibular trauma was temporally related to the onset of symptoms in eight patients. Five patients exhibiting either unilateral or bilateral AVN involving the condyles and condylar necks had undergone previous orthognathic surgery, including sagittal split mandibular osteotomies followed by intermaxillary fixation. One patient exhibiting condylar AVN with articular surface collapse and osseous destruction had undergone previous TMJ meniscectomy followed by insertion of a permanent Proplast implant. Thirty-one of 34 patients with no prior surgery and MR changes of condylar OCD/AVN had associated internal derangement of the TMJ meniscus. There was surgical confirmation of findings in 10 joints. We assert that OCD and AVN are relatively common, clinically significant lesions of the mandibular condyle often associated with preexisting internal derangement of the temporomandibular joint.

Adolescent↗
PubMed1995

Casting the implant for reconstruction of pectus excavatum.

Fourteen patients with pectus excavatum underwent a total of 17 operations for the insertion of subcutaneous implants aimed at camouflaging their defects. A silicone prosthesis in one patient early in the series caused severe capsular formation. Although a block of Proplast may occasionally be used with success, the rational solution to the problem is to produce a custom made Silastic implant that adheres optimally to the defect in each individual case. This retrospective study shows that a subcutaneous implant clearly improves the appearance of the chest wall in most of the patients.

Adolescent↗
PubMedDate not supplied

Use of a new malleable implant as a bone substitute in maxillofacial surgery.

Biocompatible osteoconductive polymer (BOP) has been used since 1979 as a substitute for bone in orthopedic surgery and neurosurgery. To date, in maxillofacial surgery, loss of bone volume as a result of either trauma or osteoporosis has been compensated for by autologous bone onlay graft or subperiosteal apposition grafts of synthetic materials. Neither of these solutions is entirely satisfactory. Autologous bone is subject to reabsorption, requiring initial overcorrection and multiple reoperations to achieve an acceptable result. Preshaped implants of Proplast, Vicryl, Gore-Tex, or silicone do not offer much flexibility, and coral granules and hydroxyapatite are difficult to handle. Finally, all foreign materials can elicit problems with tolerability. In its SP (solution/powder) form, BOP is a paste that can be molded precisely to the required shape, making it ideal for maxillofacial surgery. This study examined the long-term tolerability and facial alterations after implants of BOP in 11 patients who underwent post-trauma and cosmetic surgery.

Adult↗
PubMed1992

[Commercially available substitutes for transplants of human bone].

As alternative or supplements to transplantation of human bone in cases of bone defects or reconstructions of bones, a series of commercially available materials exist. Kieler bones, which are made from bovine bones are the oldest preparation. Kieler bones consist of up to 30% protein. This gives the bone elasticity but may also involve immunogenic reactions to the implant. Calcium phosphate, in the form of synthetic or semi-synthetic hydroxyapatite or hydroxyapatite/tricalcium phosphate, is, on the other hand, quite inelastic which makes these implants unsuitable in regions with mechanical stress. Proplast consists of carbon fibres coated with Teflon and may be employed for subperiostal reconstructions. BOP is a new system of synthetic materials built up from polyamide fibres and/or absorbable matrix. This system combines mechanical strength with ingrowth of bone but, as yet, experience with this material is only limited. Commercial substitutes for human bones should only be employed on limited indications and taking the mechanical properties of the implants and the capacity for substitution with regenerating bony tissue into consideration.

Animals↗
PubMed1991

Alloplastic cheek augmentation.

Alloplastic cheek augmentation can achieve an attractive malar prominence that is in balance and harmony with the other facial features. To reach this goal, the surgeon must first identify the proper candidate and then determine the type of malar deficiency. A vertical line through the lateral canthus allows the malar deficiency to be classified as anterior-medial, posterior-lateral, or combined. The proper implant is selected on the basis of the type of the defect and the degree of the deficiency. Different techniques are described that help the surgeon locate the site of the ideal malar eminence. Once that site is located, the surgeon outlines the proposed pocket for the implant. Both silicone and Proplast implants are successful. The insertion may be through the intraoral route, blepharoplasty approach, or under the face lift flap. The possible complications are discussed, but the complication rate is minimal.

Humans↗
PubMedDate not supplied

Experimental development of a fixed volume, gravity draining, prosthetic urinary bladder.

A fixed volume, semi-rigid, gravity draining prosthetic urinary bladder has been developed in experimental animals. The conceptual model demands: 1) an encrustation resistant lumenal surface; 2) successful urothelial-prosthesis and bowel-prosthesis anastomoses; 3) a transcutaneous abdominal wall prosthesis that bonds with skin, muscle, bladder, and peritoneum which resists external and intraluminal bacterial challenge; and 4) an air permeable, fluid impermeable filter which allows passive filling and gravity evacuation of urine. The principles involved have been successfully tested in rodents, rabbits, swine, and dogs. To date two total alloplastic prosthetic bladders fabricated from Biolor II and Proplast have been inserted in mini-swine for 4 weeks.

Animals↗
PubMed1990

Management of cerebrospinal fluid otorhinorrhea complicating the retrosigmoid approach to the cerebellopontine angle.

The retrosigmoid approach is currently used in the resection of small acoustic schwannomas or the vestibular nerve in selected patients with recurrent vertigo. Cerebrospinal fluid otorhinorrhea associated with the approach is often due to a failure to completely obliterate exposed air cells of the posteromedial and posterosuperior tracts of the temporal bone. A therapeutic protocol for managing a postoperative spinal fluid leak is outlined on the basis of these anatomic features and the status of the patient's hearing. If serviceable hearing has been preserved, the operative site is explored and incompletely obliterated or exposed cells are sealed with bone wax. If a leak persists, or if hearing is lost with the initial procedure, the mastoid cavity and middle ear cleft are obliterated with abdominal fat and the eustachian tube orifice occluded with Proplast through a facial recess approach.

Cerebellopontine Angle↗