Endoscopic procurement of allograft tympano-ossicular systems: valuable to replace the Schuknecht bone plug technique?
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ORIGINAL PAPER
Endoscopic procurement of allograft tympano-ossicular systems: valuable to replace the Schuknecht bone plug technique? Jeroen Caremans • Evert Hamans • Ludo Muylle • Paul Van de Heyning Vincent Van Rompaey
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Received: 10 March 2014 / Accepted: 1 April 2014 Springer Science+Business Media Dordrecht 2014
Abstract Recently, our group demonstrated the technical feasibility of allograft tympano-ossicular systems (ATOS) procurement directly through the external auditory canal by using a rigid endoscope. This novel technique has several advantages compared to the traditional transcranial Schuknecht bone plug technique: it avoids contact with the dura mater, it is less time-consuming and it doesn’t require a thorough reconstruction of the donor. In our tissue bank, we are currently transitioning from the transcranial procurement technique to the endoscopic procurement technique. The learning curve to master
the endoscopic technique is steep but our preliminary results suggest that the percentage of good quality endoscopically procured ATOS is at least similar to the percentage of good quality transcranially procured ATOS dissected from the temporal bone plug. Additionally, the number of donations has increased significantly. By avoiding contact with the dura mater and therefore eliminating the risk of potential prion disease transmission, this technical evolution in procurement technique might allow dedicated tissue banks to (re-)introduce ATOS procurement and implantation. Keywords Tympanic membrane Ear ossicles Endoscopy Allograft Tissue banks
J. Caremans E. Hamans L. Muylle P. Van de Heyning University of Antwerp Temporal Bone Bank, Antwerp University Hospital, Edegem, Belgium J. Caremans E. Hamans L. Muylle P. Van de Heyning Tissue and Cell Bank, Antwerp University Hospital, Edegem, Belgium E. Hamans P. Van de Heyning V. Van Rompaey (&) Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium e-mail: [email protected] E. Hamans L. Muylle P. Van de Heyning V. Van Rompaey Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
Introduction Allograft tympano-ossicular systems (ATOS) have proven their use over many decades in tympanoplasty, ossiculoplasty and reconstruction after resection of cholesteatoma (Van Rompaey et al. 2013b; Somers et al. 2004). Our group demonstrated earlier that running a tympano-ossicular tissue bank complying with European Union regulations on human allografts is feasible and critical to assure that the patient receives tissue which is safe, individually checked and prepared in a suitable environment (Van Rompaey et al. 2013a).
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Cell Tissue Bank
In order to provide en bloc ATOS (tympanic membrane and entire ossicular chain with malleus, incus and stapes attached), the transcranial bone plug technique as described by Schuknecht was used (Merchant and Nadol 2010). However, this technique has several important disa
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