ISSN 1843-6188 Scientific Bulletin of the Electrical En gineering Faculty Year 15 No.2 (30) [631623]

ISSN 1843-6188 Scientific Bulletin of the Electrical En gineering Faculty – Year 15 No.2 (30)
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COMPATIBLE BIOMATERIALS USED IN ENT PRACTICE – LITERATURE REVIEW
V. BUDU1), TATIANA DECUSEAR Ă1), RALUCA B ĂICAN1), DIANA COJOCARU1), I. BULESCU2),
MĂDĂLINA GEORGESCU1), M. TUȘALIU1), B. MOCANU3)
1) Institute of Phonoaudiology and Functional ENT Surgery “Prof. Dr. D. Hociot ă”, Bucharest
2) Chair of Anatomy, Department of Morphology, University of Medicine and Pharmacy “Carol Davila”, Bucharest
3) Monza Hospital, Bucharest
Email: [anonimizat]

Abstract. In the last years otolaryn gology was influenced by
newly developed implants which are based on both,
innovative biomaterials and novel implant technologies.
Since the biomaterials are inte grated into biological systems
they have to fulfill all tec hnical requirements and
accommodate biological interactions. Aside from all
technological challenges the selective organization of the
cell-implant interaction is of decisive relevance. The implant
may be comprised of polymers, metals, ceramics. In order to
stimulate tissue regeneration biodegradable polymers can be
utilized. Technical functionality relating to implant specific
mechanical properties, a sufficien tly high stability in terms of
physiological conditions, and good biocompatibility are the
demands with regard to suitabi lity of biomaterials. The goal
in applying biomaterials for implants is to maintain
biofunctionality over extended pe riods of time. These general
demands to biomaterials are equally valid for use in
otorhinolaryngology.
Keywords: biomaterials , implants, polymers,
otorhinolaryngology

1. INTRODUCTION

Biomaterials are represented by any substance used for
replacement and augmentation of natural or synthetic
tissues. These are used to replace a part of the body which has lost its functions b ecause of a disease and also
as a support in the process of regeneration. The quality
of a material used for an implant has to respect two
criteria: a biochemical a nd a biomechanical one.
According to the biochemical criteria the applicability of a material is determined by its biocompatibility and
strength [1].
An implant material will always be positioned in a lesion
and as a result local reacti ons will be ongoing. The
foreign body will be surrounded of a fibrous capsule, which is an indicator of cellular activity. It should be
taken into account that any biomaterial will be absorbed
to a certain extent depending on the ionic activity of the surface; since the contact ar ea is larger the cellular
response to the biomaterial will be of much more
importance.
Biomaterials corrosion can l ead to the elimination of
toxic substances such as ni ckel, cobalt, chromium causing
severe allergic reactions. Therefore the material has to be analyzed depending on th e place and where it will be
implanted [2]. In reconstruc tive surgery th ere are three classes of materials used: metals, polymers and ceramics.
They have advantages and disadvantages regarding biocompatibility, integration capability and their applicability in surgery.
2. RHINOLOGIC SURGERY

Several categories of biomaterials are used in rhinologic
surgery, such as: autogenous cartilage, homografts,
alloplastics. Alloplastics are: silicon, high density
polyethylene (Medpor), polyethylene terephthalate
(Mersilene) and polytetrafluoroethylene (Goretex).
Normal functionality of the sinus occurs when there is a
patent ostium, an ostium which is permanently open and
allows sinus drainage. In many occasions after surgery is used a sinus balloon to maintain the ostium open or a
stent (frequently used for th e frontal sinus recess). The
stent may be made of silastic, dacron, gold [3] (Figure 1).

Figure 1. Baloon for sinoplasty

Also in rhinologic surgery, in postoperative period
internal nasal splints are used and can be made of silicon,
fluoroplastic, providing support and some of them allow
postoperative nasal breathing through the integrated septal nasal tubes. Septal buttons which are made of
silicon, titanium can be used in septal perforations
(Figure 2).

Scientific Bulletin of th e Electrical Engineering Faculty – Year 15 No.2 (30) ISSN 1843-6188
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Figure 2. Nasal splint

Chronic dacryocystitis develops secondary to partial or
total obstruction of the nasolacrimal duct caused by infection or inflammation. Dacryocystorhinostomy is the
best method to treat this pathology using general or local
anesthesia. The surg eon creates a connection between the
lacrimal sac and nose using a stent to maintain the ostium
open as long as possible [4] (Figure 3).

Figure 3. Stent for lacrimal stenosis

In choanal imperforation, the rear region of the nasal
passages, is usually blocked by forming abnormal bone
or soft tissue membranous; special prosthetics made of
silicon can be used [5].
Ozena is a disease of the nose in which the bony ridges
and mucous membranes of the nose waste away. Ozena is
also called atrophic rhinitis. Several techniques are used for recovery such as implant of acrylic tabs or paraffin
[6].

3. OTOLOGIC SURGERY

Serous otitis media is a collection of non-infected fluid in the middle ear. There is usually a clear or straw coloured
fluid behind the ear drum. Surgical treatment of chronic
serous otitis media may be recommended to reestablish ventilation of the middle ear and keep the hearing at a
normal level. Myringotomy (an incision in the eardrum
membrane) is performed to remove middle ear fluid, which is drained with a ventilation tube. There are many
types of tubes, but all of them serve the same function:
they keep the eardrum open, allow air to enter the middle
ear space, and permit fluid fro m the middle ear to drain.
Most tubes will gradually be rejected by the ear and work their way out of the eardrum. Tubes will last four to six
months in the eardrum before they come out. T tubes do
not extrude by themselves. These have to be physically removed. Ventilation tubes can be made of titanium,
silastic or tephlon (Figure 4).

Figure 4. Middle ear T-tube

Otosclerosis is a disease of the bones of the middle and inner ear where the ossicles b ecome knit together into an
immovable mass. For conductive hearing loss, the
surgical procedure is staped ectomy where the stapes is
removed and replaced with a prosthetic device. There are
lots of models for pistons used for stapedectomy
depending on the local anat omy of each patient. The
pistons can be made out of hydroxyapatite, polyethylene,
tephlon or titanium. Each material has advantages and
disadvantages but in time the titanium has proven to be the best choice because is biocompatible, flexible and
easily adapted, light weighted and creates a good contact
with the middle ear ossicles [7].

Otologic dressings made out of silastic are recommended for temporary sheeting of the external auditory canal due
to the lack of adherence to tissue and by that reducing
the trauma caused by getting them out. For the reconstructive surgery of th e middle ear one can use the
ionomeric cement SerenoCem to establish the continuity
of the middle ear ossicles, to reconstruct the posterior wall of the external auditory canal, revision
stapedectomy or to stabilize the electrode of the cochlear
implant to the cochleostoma due to the optimal biocompatibility to metal and bone [8].

PAW1 biovitroceramic is a synthetic bioactive material that contains fluorhydroxyapatite micro crystals and β-
wollastonite embedded in a vitreous matrix and it is used
due to the osteoinductive feature, being well tolerated without necrosis and foreign body reaction in the
surrounding tissues [9].

The BAHA system can offer a solution to people who
need hearing amplification but have ear canal problems.
This system uses the principle of osteointegration with a small titanium screw implanted behind the ear. A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear, a second portion that is surgically placed under the skin and the electrode made out of titanium (Figure 5).

ISSN 1843-6188 Scientific Bulletin of the Electrical En gineering Faculty – Year 15 No.2 (30)
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Figure 5. Cochlear implant

4. LARYNGEAL SURGERY

In laryngeal pathology there are several types of stenosis:
posttraumatic, tumoral, iatrogenic. Laryngeal stenting is
practiced in laryngo-tracheal trauma with silicone tube,
and for the prevention of adhesions, silastic is placed in
the anterior commissure. Besides permeation methods, techniques in maintaining the luminal patency are also
required. One of the first types of stents used was the
Montgomery stent (T -tube) in 1965 (Figure 6).

Figure 6. Laryngeal stent

In addition to the silicone, also metal or hybrid stents
occured but with multiple di sadvantages (interference
with mucociliary clearance, stent intolerance in
subglottis placing, granuloma formation, reduced
flexibility in tortuous tracks). The Montgomery stent (T-
tube) has the ability to dilate in the presence of the
human body heat [10]. Also in hypopharyngeal
esophageal strictures and can be applied pharyngeal tube
[11].

The medialization is one of the first treatment techniques
for the paralysis of vocal co rds. When the vocal cords
are not close phonation is no t achieved, then the space
between them (glottis) remains open. For the vocal fold
phonatory functions, vocal cord s must come into contact
and then the paralysed vocal cord has to be medialized.
This can be done with a Gore-Tex implant, silastic, titan
which is inserted into the vocal cords to support them
[12].

There are recommended materi als for injection into the
vocal cords in treating congestive glottis. Intracordal injection of different materials (PTFE) was firstly used by Brunings in 1911. He used paraffin, but this leads to the
phenomenon of paraffin granuloma, so that was
abandoned. Arnold was the first to use tephlon in combination with glycerin in the treatment of this type of
paralysis. The temporary materials may be: bovine
gelatin, products based on collagen, hyaluronic acid, carboxymethyl cellulose; permanent materials can be: fat,
dacron, calcium hydroxyapatite, polydimethylsiloxane
(Figure 7).

Figure 7. Endolaryngeal injection

Intramuscular injectio ns can be practiced
(cricoaritenoidian tiroaritenoidian or posterior), bilateral
botulinum toxin (type A), guided by electromyography.
Injections have a chemical denervation effect of the
flaccid muscle paralysis and can be repeated after 3-6
months and require phoniatric treatment to extend this
period [13].

5. CONCLUSIONS

In conclusion, several criteria must be met before performing an implant in the human body (the
biomaterial one, a preoperative preparatory plan, a well-
established operative technique and postoperative follow-up). Different classes of materials can be used as
biomaterials. Polymer materials are best tolerated within
otorhinolaryngology. It is essential that any type of
surgery performed preserves the organs’ function as long
as possible. Increased kno wledge in the field of
biomaterials result in the development of several
innovative materials and simultaneously emphasizes the
importance of collaboration between engineering and medicine.

6. REFERENCES

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[2] Bakker D, van Blitterswijk CA, Hesseling SC, Grote
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Published online 2010 Dec 22