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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.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.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.

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

Abutments series showing (A) acute soft-tissue angle with 5.5-mm abutment when there is soft-tissue thickening and the more vertical soft-tissue lie with the (B) 8.5-mm (Cochlear) and (C) 9- or 12-mm (Oticon) abutments.
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Figure 3: Abutments series showing (A) acute soft-tissue angle with 5.5-mm abutment when there is soft-tissue thickening and the more vertical soft-tissue lie with the (B) 8.5-mm (Cochlear) and (C) 9- or 12-mm (Oticon) abutments.

Mentions: To date, we cannot confirm any particular factor that was contributory to three patients needing soft-tissue reduction. Our suspicion lies with the shape of the abutments. The near-vertical soft tissue lie (Fig. 3) obtained, when using the previously mentioned abutments, we think decreases the propensity for inflammatory reaction. To date, we have had no problems with the new Oticon abutments, except the one patient who required a change from a 9-mm abutment to a 12-mm abutment in view of soft-tissue thickness.


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)

Abutments series showing (A) acute soft-tissue angle with 5.5-mm abutment when there is soft-tissue thickening and the more vertical soft-tissue lie with the (B) 8.5-mm (Cochlear) and (C) 9- or 12-mm (Oticon) abutments.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 3: Abutments series showing (A) acute soft-tissue angle with 5.5-mm abutment when there is soft-tissue thickening and the more vertical soft-tissue lie with the (B) 8.5-mm (Cochlear) and (C) 9- or 12-mm (Oticon) abutments.
Mentions: To date, we cannot confirm any particular factor that was contributory to three patients needing soft-tissue reduction. Our suspicion lies with the shape of the abutments. The near-vertical soft tissue lie (Fig. 3) obtained, when using the previously mentioned abutments, we think decreases the propensity for inflammatory reaction. To date, we have had no problems with the new Oticon abutments, except the one patient who required a change from a 9-mm abutment to a 12-mm abutment in view of soft-tissue thickness.

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.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.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.

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