title: Complications with hydroxyapatite cement in mastoid cavity obliteration.
abstract: OBJECTIVE
  To determine whether hydroxyapatite (HA) bone cement is a suitable material for mastoid cavity obliteration.
  
  
  METHODS
  Retrospective case review; tertiary care pediatric hospital.
  
  
  METHODS
  Three patients, aged 11 to 16 years, underwent canal wall down mastoidectomy for removal of cholesteatomas.
  
  
  METHODS
  Mastoid cavity obliteration was performed with hydroxyapatite bone cement.
  
  
  METHODS
  Failure was defined as the necessity for HA explantation.
  
  
  RESULTS
  All three patients required revision surgery to remove the HA cement. Two patients (one primary and one second look with obliteration) presented with granulations in the mastoid cavity, surrounding the cement. The third patient's intraoperative findings included extensive skull base osteitis with erosion of the posterior and middle fossa dural plates, and fistulae of the lateral and superior semicircular canals. All patients recovered fully after removal of the HA cement.
  
  
  CONCLUSIONS
  This study raises concerns over the use of HA cement for mastoid cavity obliteration. Three of three implanted patients required revision surgery, two with delayed failure of integration and infection, and one with severe osteitis and significant complications.
authors.affiliation: Department of Otolaryngology, Children's Hospital, Boston, MA, USA.
authors.forename: Janell S
authors.initials: JS
authors.lastname: Ridenour
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Poe
authors.forename: David W
authors.initials: DW
authors.lastname: Roberson
mesh_terms: D000293:Adolescent; D018786:Bone Substitutes / Q000009:adverse effects*; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000473:pathology / Q000601:surgery*; D005260:Female; D006097:Granulation Tissue; D006801:Humans; D006882:Hydroxyapatites / Q000009:adverse effects*; D008297:Male; D008416:Mastoid / Q000601:surgery*; D010000:Osteitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D010027:Osteotomy; D012086:Reoperation; D019291:Skull Base; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000209:etiology / Q000601:surgery
chemical_list: D018786:Bone Substitutes; D006882:Hydroxyapatites; C475044:hydroxyapatite cement