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Percutaneous bone-anchored hearing implant surgery without soft-tissue reduction: up to 42 months of follow-up.

Singam S, Williams R, Saxby C, Houlihan FP - Otol. Neurotol. (2014)

Bottom Line: Unlike in traditional techniques where all dermal and subcutaneous tissue and muscle are removed to enable the thinned skin to sit directly on the periosteum, here, in our series, using the WoSR technique, the soft tissue was preserved and only longer abutments (8.5, 9, and 12 mm) were used.Of the 30 patients, 25 have had no postoperative problems and five had mild inflammation, of which three patients developed intractable pain and underwent soft-tissue reduction.The technique WoSR for BAHI surgery seems to be a safe technique with consistently good results, decreasing operating time and patient morbidity and avoiding some of the complications seen in traditional techniques using soft-tissue reduction.

View Article: PubMed Central - PubMed

Affiliation: *Torbay Hospital, Devon; and †Institute of Naval Medicine, Gosport, England, United Kingdom.

ABSTRACT

Objective: To report the results of bone-anchored hearing implant (BAHI) surgery without soft-tissue reduction (WoSR); in our case, a series of 30 patients with a follow-up period of up to 42 months.

Patients: The study group included 30 patients between ages 17 and 79 years, where BAHI was indicated, during a 42-month period, between February 2010 and July 2013. Initially, only patients with medical comorbidities that could compromise wound healing were offered the procedure but, subsequently, all our patients are now offered this technique.

Intervention: Unlike in traditional techniques where all dermal and subcutaneous tissue and muscle are removed to enable the thinned skin to sit directly on the periosteum, here, in our series, using the WoSR technique, the soft tissue was preserved and only longer abutments (8.5, 9, and 12 mm) were used.

Main outcome measure: Good early postoperative wound healing, absence of flap necrosis, absence of numbness around the surgical site, and trouble-free follow-up period, with 25 patients encountering no complications.

Results: Of the 30 patients, 25 have had no postoperative problems and five had mild inflammation, of which three patients developed intractable pain and underwent soft-tissue reduction.

Conclusion: The technique WoSR for BAHI surgery seems to be a safe technique with consistently good results, decreasing operating time and patient morbidity and avoiding some of the complications seen in traditional techniques using soft-tissue reduction.

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Related in: MedlinePlus

Soft-tissue problems (A) with the 9-mm abutment (B) necessitating change to a 12-mm abutment in this patient with a very thick scalp; (C) 12-mm abutment sitting proud. (D) One month after the abutment change, the patient was asymptomatic.
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Figure 2: Soft-tissue problems (A) with the 9-mm abutment (B) necessitating change to a 12-mm abutment in this patient with a very thick scalp; (C) 12-mm abutment sitting proud. (D) One month after the abutment change, the patient was asymptomatic.

Mentions: - four patients suffered chronic inflammation. One was associated with thicker than average soft tissue. The undue thickness of the soft tissue was noted preoperatively, but the 9-mm abutment was the longest available in the market at that time and my reluctance to proceed with soft-tissue reduction because the patient has not consented for the same and was on aspirin for arrhythmia. The 9-mm abutment was used. This, as anticipated, caused persistent mild soft-tissue inflammation, with pain starting about 4 weeks after surgery and was aggravated by the use of the aid. The 9-mm Oticon abutment (Oticon Medical, Copenhagen, Denmark), initially fitted, was subsequently replaced with a 12-mm Oticon alternative (which fortunately was launched on a controlled market release shortly afterward). The patient experienced complete resolution of symptoms (Fig. 2).


Percutaneous bone-anchored hearing implant surgery without soft-tissue reduction: up to 42 months of follow-up.

Singam S, Williams R, Saxby C, Houlihan FP - Otol. Neurotol. (2014)

Soft-tissue problems (A) with the 9-mm abutment (B) necessitating change to a 12-mm abutment in this patient with a very thick scalp; (C) 12-mm abutment sitting proud. (D) One month after the abutment change, the patient was asymptomatic.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554229&req=5

Figure 2: Soft-tissue problems (A) with the 9-mm abutment (B) necessitating change to a 12-mm abutment in this patient with a very thick scalp; (C) 12-mm abutment sitting proud. (D) One month after the abutment change, the patient was asymptomatic.
Mentions: - four patients suffered chronic inflammation. One was associated with thicker than average soft tissue. The undue thickness of the soft tissue was noted preoperatively, but the 9-mm abutment was the longest available in the market at that time and my reluctance to proceed with soft-tissue reduction because the patient has not consented for the same and was on aspirin for arrhythmia. The 9-mm abutment was used. This, as anticipated, caused persistent mild soft-tissue inflammation, with pain starting about 4 weeks after surgery and was aggravated by the use of the aid. The 9-mm Oticon abutment (Oticon Medical, Copenhagen, Denmark), initially fitted, was subsequently replaced with a 12-mm Oticon alternative (which fortunately was launched on a controlled market release shortly afterward). The patient experienced complete resolution of symptoms (Fig. 2).

Bottom Line: Unlike in traditional techniques where all dermal and subcutaneous tissue and muscle are removed to enable the thinned skin to sit directly on the periosteum, here, in our series, using the WoSR technique, the soft tissue was preserved and only longer abutments (8.5, 9, and 12 mm) were used.Of the 30 patients, 25 have had no postoperative problems and five had mild inflammation, of which three patients developed intractable pain and underwent soft-tissue reduction.The technique WoSR for BAHI surgery seems to be a safe technique with consistently good results, decreasing operating time and patient morbidity and avoiding some of the complications seen in traditional techniques using soft-tissue reduction.

View Article: PubMed Central - PubMed

Affiliation: *Torbay Hospital, Devon; and †Institute of Naval Medicine, Gosport, England, United Kingdom.

ABSTRACT

Objective: To report the results of bone-anchored hearing implant (BAHI) surgery without soft-tissue reduction (WoSR); in our case, a series of 30 patients with a follow-up period of up to 42 months.

Patients: The study group included 30 patients between ages 17 and 79 years, where BAHI was indicated, during a 42-month period, between February 2010 and July 2013. Initially, only patients with medical comorbidities that could compromise wound healing were offered the procedure but, subsequently, all our patients are now offered this technique.

Intervention: Unlike in traditional techniques where all dermal and subcutaneous tissue and muscle are removed to enable the thinned skin to sit directly on the periosteum, here, in our series, using the WoSR technique, the soft tissue was preserved and only longer abutments (8.5, 9, and 12 mm) were used.

Main outcome measure: Good early postoperative wound healing, absence of flap necrosis, absence of numbness around the surgical site, and trouble-free follow-up period, with 25 patients encountering no complications.

Results: Of the 30 patients, 25 have had no postoperative problems and five had mild inflammation, of which three patients developed intractable pain and underwent soft-tissue reduction.

Conclusion: The technique WoSR for BAHI surgery seems to be a safe technique with consistently good results, decreasing operating time and patient morbidity and avoiding some of the complications seen in traditional techniques using soft-tissue reduction.

Show MeSH
Related in: MedlinePlus