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Yamada A, Chwa ES, Boctor MJ. Update on Total Auricular Construction. Plast Reconstr Surg 2024; 153:1011e-1021e. [PMID: 38657012 DOI: 10.1097/prs.0000000000011219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand principles of preoperative planning for microtia repair. 2. Understand key techniques for flap design, skin envelope dissection, framework creation, and donor-site reconstruction. 3. Describe important components of postoperative management. SUMMARY Total auricular construction remains a challenge for reconstructive surgeons. This article describes current surgical strategies and advancements for microtia construction. The authors' focus is to describe the several keys for success that are useful for young surgeons who wish to train themselves to create satisfactory results.
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Affiliation(s)
- Akira Yamada
- From the Division of Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital
- Northwestern University Feinberg School of Medicine
| | - Emily S Chwa
- Northwestern University Feinberg School of Medicine
| | - Michael J Boctor
- Northwestern University Feinberg School of Medicine
- Department of Plastic Surgery, Loma Linda University Health
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2
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Kim HAJ, Namavarian A, Khan U, Levy BB, Ziai H, Talei B, Gantous A. Reconstructive Techniques in Pediatric Congenital Microtia: A Systematic Review and Meta-analysis. Facial Plast Surg 2024. [PMID: 38232751 DOI: 10.1055/a-2247-5109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Autografts and allografts are commonly used in microtia reconstruction. We aimed to systematically review and compare these reconstructive materials in pediatric congenital microtia reconstruction. A systematic review of the literature was performed. MEDLINE, Embase, PubMed, Web of Science, and CINAHL databases were searched for original studies on congenital microtia reconstruction in pediatric patients since database inception to 2021. Microtia grade was stratified as high or low. Meta-analysis of pooled proportions and continuous variables was performed using inverse variance weighting with a random effects model to compare between the autograft and allograft groups. Sixty-eight studies with a total of 5,546 patients used autografts (n = 5,382) or alloplastic implants (n = 164). Four other studies used prosthesis, cadaveric homografts, or tissue engineering. The allograft group was on average younger than the autograft group (8.4 vs. 11.1 years). There were no syndromic patients in the allograft group, compared to 43% in the autograft group. Patients treated with allografts had higher microtia grade than those treated with autograft (98 vs. 72%). Autografts were more commonly utilized by plastic surgeons and allografts by otolaryngologists (95 vs. 38%). No autografts and 41% of allografts were done concurrently with atresiaplasty or bone conduction implant. Satisfaction rates were similarly high (>90%) with similar complication rates (<10%). Microtia reconstruction using autografts and allografts had similar satisfaction and complication rates. Allografts were preferred for younger patients and concurrent hearing restoration. Further large-scale studies are required to evaluate the long-term efficacy of these reconstructive techniques.
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Affiliation(s)
- Hugh Andrew Jinwook Kim
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amirpouyan Namavarian
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Urooj Khan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ben B Levy
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Ben Talei
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Andres Gantous
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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3
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Bruschini L, Canzi P, Canale A, Covelli E, Laborai A, Monteforte M, Cinquini M, Barbara M, Beltrame MA, Bovo R, Castigliano B, De Filippis C, Della Volpe A, Dispenza F, Marsella P, Mainardi A, Orzan E, Piccirillo E, Ricci G, Quaranta N, Cuda D. Implantable hearing devices in clinical practice. Systematic review and consensus statements. Acta Otorhinolaryngol Ital 2024; 44:52-67. [PMID: 38165206 PMCID: PMC10914359 DOI: 10.14639/0392-100x-n2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024]
Abstract
Objective Implantable hearing devices represent a modern and innovative solution for hearing restoration. Over the years, these high-tech devices have increasingly evolved but their use in clinical practice is not universally agreed in the scientific literature. Congresses, meetings, conferences, and consensus statements to achieve international agreement have been made. This work follows this line and aims to answer unsolved questions regarding examinations, selection criteria and surgery for implantable hearing devices. Materials and methods A Consensus Working Group was established by the Italian Society of Otorhinolaryngology. A method group performed a systematic review for each single question to identify the current best evidence on the topic and to guide a multidisciplinary panel in developing the statements. Results Twenty-nine consensus statements were approved by the Italian Society of Otorhinolaryngology. These were associated with 4 key area subtopics regarding pre-operative tests, otological, audiological and surgical indications. Conclusions This consensus can be considered a further step forward to establish realistic guidelines on the debated topic of implantable hearing devices.
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Affiliation(s)
- Luca Bruschini
- Otolaryngology, ENT Audiology and Phoniatrics Unit, University Hospital of Pisa, Pisa, Italy
| | - Pietro Canzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Canale
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Andrea Laborai
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marta Monteforte
- Laboratory of systematic review methodology and guidelines production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michela Cinquini
- Laboratory of systematic review methodology and guidelines production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Millo Achille Beltrame
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Bovo
- Department of Neuroscience DNS, Otolaryngology Section, Padua University, Padua, Italy
| | - Bruno Castigliano
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Cosimo De Filippis
- Department of Neuroscience, Audiology Section, University of Padua, Treviso, Italy
| | - Antonio Della Volpe
- Otology and Cochlear Implant Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Francesco Dispenza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘’Paolo Giaccone’’, University of Palermo, Palermo, Italy
| | - Pasquale Marsella
- Audiology and Otosurgery Department, “Bambino Gesù” Children’s Hospital, Rome, Italy
| | - Anna Mainardi
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Eva Orzan
- ENT and Audiology Unit, Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Giampietro Ricci
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy
| | - Nicola Quaranta
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy
| | - Domenico Cuda
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Seiwerth I, Plößl S, Herzog M, Schilde S, Radetzki F, Krämer S, Rahne T, Plontke SK. Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia. HNO 2023; 71:1-9. [PMID: 36083471 PMCID: PMC10409664 DOI: 10.1007/s00106-022-01190-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The simultaneous implantation of the Bonebridge (MED-EL, Innsbruck, Austria), a semi-implantable active transcutaneous bone conduction hearing device and anchors for auricular prostheses can be challenging as both implants contain magnets and compete for the narrow space in the designated implantation area. MATERIAL AND METHODS A preoperative planning tool (virtual surgery) was used with individual 3D computer models of the skull and implants for finding optimal implant positions for both the floating mass transducer (FMT) and the anchors for the auricular prosthesis. The interaction between the magnetic prosthesis anchors and the FMT was measured by means of static magnetic forces. A retrospective data analysis was conducted to evaluate the surgical and audiological outcome. RESULTS Between 2014 and 2021, a 3D planning of a simultaneous implantation of the Bonebridge with auricular prosthesis anchors was conducted on 6 ears of 5 patients (3 males, 2 females; age range 17-56 years). The individual preoperative planning was considered very useful for the optimal placement of bone anchors in combination with the Bonebridge. Audiological data showed a clear benefit for hearing 3 months and > 11 months after implantation. No adverse interactions between the magnetic prosthesis anchors and the FMT were observed. In two patients, revision surgery was carried out due to skin inflammation or wound healing problems. No long-term complications were observed 3-5 years after surgery. CONCLUSION Preoperative 3D planning represents a clear benefit for the simultaneous audiological and esthetic rehabilitation using the Bonebridge and anchors for auricular prostheses.
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Affiliation(s)
- Ingmar Seiwerth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Sebastian Plößl
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Martha-Maria Hospital Halle-Dölau, Halle (Saale), Germany
| | - Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Otorhinolaryngology, Carl Thiem Klinikum, Cottbus, Germany
| | - Sebastian Schilde
- Department of Orthopedic and Trauma Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Florian Radetzki
- Department of Orthopedic and Trauma Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Orthopedic und Trauma Surgery, Brandenburg Medical School Theodor Fontane, Klinikum Dessau, Dessau, Germany
| | | | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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5
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Kulich M, Patel VA, Rezvan PH, Osterbauer B, Kochhar A, Gomez G. Dual Option Microtia Clinic: A Comparison of Outcomes in Microtia Reconstruction Using Autologous Rib or Porous Polyethylene Implant. Facial Plast Surg Aesthet Med 2023; 25:290-295. [PMID: 37083442 DOI: 10.1089/fpsam.2022.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Introduction: Auricular reconstruction techniques most frequently utilize either autologous costal cartilage or alloplastic porous polyethylene (PPE) implant. Objectives: To compare the aesthetic outcomes, number of surgeries, and complications in children who underwent microtia reconstruction with either rib or PPE implant by blinded photograph review. Methods: This retrospective cohort study included consecutive pediatric patients who underwent auricular reconstruction with either autologous cartilage or PPE between November 2017 and February 2022. Blinded observers rated each postoperative ear through a web-based survey. Data on patient characteristics, operative time, length of admission, and complications were collected, bivariate analyses were performed using chi-square or Fisher's exact tests for categorical variables and Wilcoxon rank-sum test for continuous variables. Results: Forty-four ears were included, 28 of which (63.6%) were reconstructed with cartilage. Median patient age was 8 years (range 4-18 years) and 29 (65.9%) were male. The cartilage group had more surgeries (median 2.5 vs. 1.0, p < 0.001), and total operating time across all surgeries did not differ significantly. Conclusion: The two groups in our study had similar rates of complications and aesthetic scores, and aesthetic scores were worse for ears with wound complications requiring unplanned revisions.
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Affiliation(s)
- Marta Kulich
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Vijay A Patel
- Department of Otolaryngology, Rady Children's Hospital-San Diego, San Diego, California, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Panteha Hayati Rezvan
- Biostatistics and Data Analysis Core, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Beth Osterbauer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Amit Kochhar
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Gabriel Gomez
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
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Sprinzl G, Toner J, Koitschev A, Berger N, Keintzel T, Rasse T, Baumgartner WD, Honeder C, Magele A, Plontke S, Götze G, Schmutzhard J, Zelger P, Corkill S, Lenarz T, Salcher R. Multicentric study on surgical information and early safety and performance results with the Bonebridge BCI 602: an active transcutaneous bone conduction hearing implant. Eur Arch Otorhinolaryngol 2023; 280:1565-1579. [PMID: 36625869 PMCID: PMC9988757 DOI: 10.1007/s00405-022-07792-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/10/2022] [Indexed: 01/11/2023]
Abstract
AIM This European multicentric study aimed to prove safety and performance of the Bonebridge BCI 602 in children and adults suffering from either conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided sensorineural deafness (SSD). METHODS 33 patients (13 adults and 10 children with either CHL or MHL and 10 patients with SSD) in three study groups were included. Patients were their own controls (single-subject repeated measures), comparing the unaided or pre-operative to the 3-month post-operative outcomes. Performance was evaluated by sound field thresholds (SF), word recognition scores (WRS) and/or speech reception thresholds in quiet (SRT) and in noise (SNR). Safety was demonstrated with a device-specific surgical questionnaire, adverse event reporting and stable pure-tone measurements. RESULTS The Bonebridge BCI 602 significantly improved SF thresholds (+ 25.5 dB CHL/MHL/SSD), speech intelligibility in WRS (+ 68.0% CHL/MHL) and SRT in quiet (- 16.5 dB C/MHL) and in noise (- 3.51 dB SNR SSD). Air conduction (AC) and bone conduction (BC) thresholds remained stable over time. All adverse events were resolved, with none unanticipated. Mean audio processor wearing times in hours [h] per day for the CHL/MHL group were ~ 13 h for adults, ~ 11 h for paediatrics and ~ 6 h for the SSD group. The average surgical length was 57 min for the CHL/MHL group and 42 min for the SSD group. The versatility of the BCI 602 (reduced drilling depth and ability to bend the transition for optimal placement) allows for treatment of normal, pre-operated and malformed anatomies. All audiological endpoints were reached. CONCLUSIONS The Bonebridge BCI 602 significantly improved hearing thresholds and speech understanding. Since implant placement follows the patient's anatomy instead of the shape of the device and the duration of surgery is shorter than with its predecessor, implantation is easier with the BCI 602. Performance and safety were proven for adults and children as well as for the CHL/MHL and SSD indications 3 months post-operatively.
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Affiliation(s)
- Georg Sprinzl
- Hals-Nasen-Ohren-Abteilung, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften und Karl-Landsteiner Institut für Implantierbare Hörsysteme, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100 St. Pölten, Austria
| | - Joseph Toner
- Regional Auditory Implant Centre, Beech Hall Centre, Belfast, Northern Ireland, UK
| | - Assen Koitschev
- Klinik für HNO-Krankheiten, Plastische Operationen, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Nadine Berger
- Klinik für HNO-Krankheiten, Plastische Operationen, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Thomas Keintzel
- Abteilung für Hals-, Nasen-, Ohrenkrankheiten, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Thomas Rasse
- Abteilung für Hals-, Nasen-, Ohrenkrankheiten, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Wolf-Dieter Baumgartner
- Allgemeines Krankenhaus der Stadt Wien, Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, Vienna, Austria
| | - Clemens Honeder
- Allgemeines Krankenhaus der Stadt Wien, Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, Vienna, Austria
| | - Astrid Magele
- Hals-Nasen-Ohren-Abteilung, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften und Karl-Landsteiner Institut für Implantierbare Hörsysteme, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100 St. Pölten, Austria
| | - Stefan Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gerrit Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Joachim Schmutzhard
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Philipp Zelger
- Universitätsklinik für Hör-, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Stephanie Corkill
- Regional Auditory Implant Centre, Beech Hall Centre, Belfast, Northern Ireland, UK
| | - Thomas Lenarz
- Medizinische Hochschule Hannover, Klinik und Poliklinik für HNO-Heilkunde, Hannover, Germany
| | - Rolf Salcher
- Medizinische Hochschule Hannover, Klinik und Poliklinik für HNO-Heilkunde, Hannover, Germany
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7
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Seiwerth I, Plößl S, Herzog M, Schilde S, Radetzki F, Krämer S, Rahne T, Plontke SK. [Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia. German version]. HNO 2022. [PMID: 35920881 DOI: 10.1007/s00106-022-01189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The simultaneous implantation of the Bonebridge (MED-EL, Innsbruck, Austria), a semi-implantable active transcutaneous bone conduction hearing device and anchors for auricular prostheses can be challenging as both implants contain magnets and compete for the narrow space in the designated implantation area. MATERIAL AND METHODS A preoperative planning tool (virtual surgery) was used with individual 3D computer models of the skull and implants for finding optimal implant positions for both the floating mass transducer (FMT) and the anchors for the auricular prosthesis. The interaction between the magnetic prosthesis anchors and the FMT was measured by means of static magnetic forces. A retrospective data analysis was conducted to evaluate the surgical and audiological outcome. RESULTS Between 2014 and 2021 a 3D planning of a simultaneous implantation of the Bonebridge with auricular prosthesis anchors was conducted on 6 ears of 5 patients (3 males, 2 females; age range 17-56 years). The individual preoperative planning was considered very useful for the optimal placement of bone anchors in combination with the Bonebridge. Audiological data showed a clear benefit for hearing 3 months and > 11 months after implantation. No adverse interactions between the magnetic prosthesis anchors and the FMT were observed. In two patients, revision surgery was carried out due to skin inflammation or wound healing problems. No long-term complications were observed 3-5 years after surgery. CONCLUSION Preoperative 3D planning represents a clear benefit for the simultaneous audiological and esthetic rehabilitation using the Bonebridge and anchors for auricular prostheses.
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8
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Wang D, Wang B, Ren R, Wang Y, Yang J, Chen P, Zhao S, Zhang Q. Total auricular reconstruction concomitant with BONEBRIDGE implantation using a retrosigmoid sinus approach. Acta Otolaryngol 2022; 142:470-475. [PMID: 35736793 DOI: 10.1080/00016489.2022.2086999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Retrosigmoid sinus (RS) approach was not the dominant choice for BONEBRIDGE implantation. OBJECTIVE To investigate the efficacy and safety of auricular reconstruction concomitant with BONEBRIDGE implantation using retrosigmoid approach for aural atresia patients. MATERIALS AND METHODS A retrospective analysis was conducted of 15 children (28 ears) who underwent auricular reconstruction using a completely expanded postauricular flap with a skin expander concomitant with retrosigmoid BONEBRIDGE implantation from July 2019 to September 2020. RESULTS All 15 patients healed well and had no bone conduction shift. Average SFT improvement was 27.1 dB HL (p < .001). Comparison between aided and unaided speech recognition rate in quiet and in noise showed significant improvements, respectively (p < .001). After a follow-up of 21-35 months, the hearing results were stable and the aesthetic outcomes were satisfying. CONCLUSIONS AND SIGNIFICANCE For patients who undergo auricle reconstruction using expanded postauricular flap, retrosigmoid approach can avoid interfering the flap of reconstructed auricular without increasing the surgical risk or impact the clinical efficacy, and without significantly prolonging the total anesthesia time. The integrated surgical approach is a safe, and convenient option for patients who require simultaneous auricular reconstruction with BONEBRIDGE implantation.
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Affiliation(s)
- Danni Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Otolaryngology, Beijing, China
| | - Bingqing Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ran Ren
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Otolaryngology, Beijing, China
| | - Yue Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinsong Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Otolaryngology, Beijing, China
| | - Peiwei Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Otolaryngology, Beijing, China
| | - Shouqin Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Otolaryngology, Beijing, China
| | - Qingguo Zhang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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9
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Ma Y, Lloyd MS. Systematic Review of Medpor Versus Autologous Ear Reconstruction. J Craniofac Surg 2022; 33:602-606. [PMID: 34643598 DOI: 10.1097/scs.0000000000008130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
ABSTRACT Ear reconstruction is 1 of the most technically challenging sub-specialties of craniofacial and reconstructive plastic surgery. The reconstructive ear must not only fulfil the requirement of being aesthetically pleasing but must also have good vascularity with a low complication rate. Several ear reconstructive techniques have been developed such as the autologous ear reconstruction technique using costal cartilage and ear reconstruction with high-density porous polyethylene or Medpor (Porex Surgical, Inc, College Park, GA). Autologous ear reconstructive techniques have advantages of durability and low infection rates however are associated with poorer aesthetic outcomes such as poor projection of the ear. Medpor has advantages of a more consistent three-dimensional definition without the need to harvest costochondral cartilage and create a donor site. However, due to its alloplastic material properties, Medpor has historically been reported as having a higher rate of extrusion and infection. This is the first systematic review to compare the outcomes of both techniques. The 6 studies that were reviewed were analyzed against 3 evaluative criteria: aesthetic outcome, complication rate, and convenience of intervention. This is so a comprehensive, evidence-based decision can be made by the surgeon and patient when ear reconstruction is required. The results showed heterogeneity in data and a lack of detailed descriptions of the assessment for aesthetic outcomes and convenience, hence were inconclusive. The results however showed that there were more complications with Medpor framework with 15% of total cases resulting in either extrusion or infection compared to 2% of autologous ear reconstruction framework.
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Affiliation(s)
| | - Mark Sheldon Lloyd
- Birmingham Women's and Children's Hospital NHS Trust, Birmingham, United Kingdom
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10
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Hundertpfund J, Meyer JE, Ovari A. Long-term audiological benefit with an active transcutaneous bone-conduction device: a retrospective cohort analysis. Eur Arch Otorhinolaryngol 2021; 279:3309-3326. [PMID: 34424382 DOI: 10.1007/s00405-021-07031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate long-term audiological, surgical and safety outcomes of a complex patient cohort treated with an active transcutaneous bone-conduction device (tBCD). METHODS This retrospective, monocentric cohort analysis involves 31 adults with conductive (CHL) and mixed hearing loss (MHL). For outcome analysis, study results were divided into short-term follow-up data (< 12 months) and long-term follow-up data (> 12 months). RESULTS 31 patients with a total person-time of 90.4 years and an average number of 3.2 ± 1.5 preoperatively performed surgeries on the implanted side were investigated. Mean BCD-aided PTA4 thresholds were significantly lower than unaided PTA4AC before surgery (64.7 ± 16.1 dB HL; CHL 50.6 ± 10.6 dB HL; MHL 72.8 ± 12.8 dB HL) and did not change between short-term (42.3 ± 13.1 dB HL; CHL 35.8 ± 6.8 dB HL; MHL 45.2 ± 14.3 dB HL) and long-term (43.4 ± 10.0 dB HL; CHL 35.8 ± 4.3 dB HL; MHL 48.1 ± 9.6 dB HL) follow-up periods. Speech intelligibility in the Freiburg monosyllables test at 65 dB improved significantly, from 16.3 ± 21.5% (CHL 26.8 ± 19.0%; MHL 8.7 ± 20.5%) in the unaided condition to 82.7 ± 15.5% (CHL 90.0 ± 12.2%; MHL 79.4 ± 16.3%) in the short-term and 85.5 ± 13.2% (CHL 93.8 ± 7.9%; MHL 79.5 ± 13.3%) BCD-aided in the long-term follow-up periods. Ten minor procedure-related and 6 implant-related (5 minor, 1 major) AEs occurred over the total follow-up period. CONCLUSION The device provides satisfactory audiological and speech benefit over long-term follow-up periods, up to 7 years. Explant rates were very low, while the overall rate of manageable AEs was high in this complex patient cohort. The device is considered a safe and effective option in the long-term hearing rehabilitation of patients with CHL and MHL.
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Affiliation(s)
| | - Jens Eduard Meyer
- Asklepios Medical School, Semmelweis University, Hamburg, Germany.,Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Attila Ovari
- Asklepios Medical School, Semmelweis University, Hamburg, Germany. .,Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany. .,Department of Oto-Rhino-Laryngology, Head and Neck Surgery, "Otto Koerner", University Medical Center, Rostock, Germany.
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Volgger V, Schießler IT, Müller J, Schrötzlmair F, Pollotzek M, Hempel JM. Audiological results and subjective benefit of an active transcutaneous bone-conduction device in patients with congenital aural atresia. Eur Arch Otorhinolaryngol 2021; 279:2345-2352. [PMID: 34173875 PMCID: PMC8986742 DOI: 10.1007/s00405-021-06938-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To review functional and subjective benefit after implantation of an active transcutaneous bone conduction device (BCD) in patients with congenital microtia with atresia or stenosis of the external auditory canal. METHODS Retrospective chart analysis and questionnaire on the subjective impression of hearing ( Speech, Spatial and Qualities of Hearing Scale (SSQ-B) of patients treated between 2012 and 2015. RESULTSRESULTS 18 patients (24 ears) with conductive or mixed hearing loss in unilateral (n = 10) or bilateral (n = 8) atresia were implanted with a BCD. No major complications occurred after implantation. Preoperative unaided air conduction pure tone average at 0.5, 1, 2 and 4 kHz (PTA 4 ) was 69.2 ± 11.7 dB, while postoperative aided PTA 4 was 33.4 ± 6.3 dB, resulting in a mean functional hearing gain of 35.9 +/- 15.6 dB. Preoperatively, the mean monosyllabic word recognition score was 22.9 % ± 22.3 %, which increased to 87.1 % +/- 15.1 % in the aided condition. The Oldenburger Sentence Test at S0N0 revealed a decrease in signal-to-noise-ratio from - 0.58 ± 4.40 dB in the unaided to - 5.67 ± 3.21 dB in the postoperative aided condition for all patients investigated. 15 of 18 patients had a subjective benefit showing a positive SSQ-B score (mean 1.7). CONCLUSION The implantation of an active bone conduction device brings along subjective and functional benefit for patients with conductive or combined hearing loss.
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Affiliation(s)
- Veronika Volgger
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Inge Teresa Schießler
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Joachim Müller
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Florian Schrötzlmair
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Marlene Pollotzek
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - John Martin Hempel
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Jiang C, Zhao C, Chen B, Lu L, Sun Y, Yan X, Yi B, Wu H, Shi R. Auricular reconstruction using Medpor combined with different hearing rehabilitation approaches for microtia. Acta Otolaryngol 2021; 141:572-578. [PMID: 33823748 DOI: 10.1080/00016489.2021.1900601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Congenital microtia-atresia affects patients in two specific ways: severe conductive hearing loss and difficulty in integrating into social environments due to auricle malformation. AIMS/OBJECTIVES To investigate the safety and efficacy of single-stage auricular reconstruction and hearing rehabilitation in children with microtia and external auditory canal atresia. MATERIAL AND METHODS From January 2016 to December 2019, we included 32 patients with microtia and external canal atresia who received auricle reconstruction with high-density polyethylene (Medpor) framework and three different hearing rehabilitation approaches at the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Twenty patients underwent the traditional external auditory canal and middle ear repair (EACR), eight patients were implanted with Bonebridge (BB) devices, and four patients were implanted with bone-anchored hearing aid (BAHA) in one stage. Postoperative changes in auricle morphology and hearing and speech recognition and occurrence of complications were evaluated. RESULTS After 6-24 months of follow-up, the auricle shape recovered well in all three groups, and the average score of 14 fine structures in the auricle was 9.43 (EACR), 10.67 (BB), and 9.75 (BAHA) points. The average score of auricle symmetry was 6.83 (EACR), 6.00 (BB), and 6.44 (BAHA) points. No significant differences in auricle shape were observed among the three groups (p > .05). After surgery, the average hearing improvement in the BB group was 43.33 dB, and the average speech recognition threshold declined to 42.28 dB. In the BAHA group, the average hearing improvement was 35 dB, and the average speech recognition threshold declined to 33.5 dB, similar to that of the BB group. However, in the EACR group, the average hearing improvement was only 4.13 dB, and the average speech recognition threshold declined to 11.36 dB. No vertigo, tinnitus, cerebrospinal fluid leakage, facial nerve paralysis, osseointegration failure, and other complications occurred in all the patients. In the EACR group, auricle stent fracture, ear canal restenosis, and canal atresia occurred in one patient each. In the BAHA group, two patients developed local ear infections. CONCLUSIONS AND SIGNIFICANCE The procedure of single-stage auricular reconstruction and hearing rehabilitation for microtia is feasible and effective. The appropriate method of hearing reconstruction should be determined by evaluating the development of the inner and middle ear of the patients. For those patients with poor development of the mastoid and ossicular chain, hearing aid devices are recommended to achieve a stable and significant hearing effect.
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Affiliation(s)
- Chenyan Jiang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Transitional Medicine of Nose and Ear Diseases, Shanghai, China
| | - Chen Zhao
- Department of Geriatric Rehabilitation, Shibei Hospital, Shanghai, China
| | - Bin Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Transitional Medicine of Nose and Ear Diseases, Shanghai, China
| | - Lixin Lu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxin Sun
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Yan
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Transitional Medicine of Nose and Ear Diseases, Shanghai, China
| | - Bin Yi
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Transitional Medicine of Nose and Ear Diseases, Shanghai, China
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Transitional Medicine of Nose and Ear Diseases, Shanghai, China
| | - Runjie Shi
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Transitional Medicine of Nose and Ear Diseases, Shanghai, China
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Chang S. Simultaneous auricular reconstruction combined with bone bridge implantation-letter. J Formos Med Assoc 2019; 118:1272. [PMID: 31031058 DOI: 10.1016/j.jfma.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Shihi Chang
- Auricular Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, 100144, China.
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