Abstract
Purpose
Techniques for Baha® implantation continue to evolve. The Weber technique, utilizing a 1.5 cm horizontal incision for Baha® implantation is evaluated.
Methods
Retrospective review of patients undergoing Baha® implantation by a single surgeon over three years.
Results
33 Baha®s implanted in 30 patients. Fourteen used an Inverted J (IJ) incision with an anteriorly-based skin-flap, 13 with the Weber technique (W). Five were not included as other techniques were used. Demographics and weeks to activation (14.58 vs 13.4, p = 0.12) were similar. There were no differences in the number of patients with minor complications (5 vs 2, p = 0.22) or number of minor complications (20 vs 4, p = 0.09). One patient in the IJ Group required operative revision for overgrowth. There were no infections in the IJ Group, and one requiring oral antibiotics in the W Group. Follow-up was longer in the IJ Group (41 vs 13 weeks, p = 0.016), no complications occurred after 14 weeks post-op. Mean operative times were similar (43 vs 39 min, p = 0.59). There were no cases of skin flap necrosis in either group.
Conclusion
A small incision for Baha® implantation proved as effective, without increased complications as a skin-flap based technique.
1
Introduction
The Bone anchored hearing aid (Baha®) implant offers a highly beneficial option for the rehabilitation of patients with conductive or unilateral sensorineural hearing loss. Since its inception, the surgical technique has been modified to minimize disruption of the soft tissue, surgical times, and post-operative complications. Original implantation techniques involved the utilization of full or partial thickness skin grafts and considerable soft tissue dissection . The postoperative course of a significant number of these patients was marred by graft loss or skin reaction . More recently, vertical or curved-vertical incisions measuring 4–5 cm have become popular .
We present the results of a truly minimally invasive technique originally proposed by Peter Weber . This technique, performed under local anesthesia, involves making a small (1.5 cm) horizontal incision, minimal undermining or resection of surrounding soft tissue, and a simple two-suture closure. We present data comparing the Weber technique with a more traditional technique in terms of surgical time, major and minor complications, and failure rate.
2
Materials and methods
A retrospective chart review was performed of all Baha® implantations by a single surgeon (MR) over a three-year period. This time period included patients in whom the implant was performed using an inverted J incision, and those performed with the new Weber technique (described below). Demographics, infection rate, time to activation, operative time, and subsequent procedures were included in the analysis. Demographics, operative time, time to activation, and follow up time were compared using a t-test, the Fisher’s exact test was used for complications.
Operative techniques
Both techniques were performed under local anesthesia with or without sedation in an outpatient surgical center. The site of the implant was marked 5 to 6 cm posteriosuperior to the EAC and an area of the surrounding scalp was shaved and prepped in standard sterile fashion. Local anesthetic was administered to areas of proposed incision and dissection.
For the ‘inverted-J’ technique a curvilinear incision was carried to the level of the periosteum to create an anteriorly based skin flap with approximately 2 cm of tissue between the incision and the implant site (Similar to Fig. 1 B ). The skin flap was thinned and the subcutaneous tissues removed. The periosteum was then removed 4 mm surrounding the implant site and the titanium implant was drilled into place in the traditional fashion. A punch was used to create a defect in the skin flap where the abutment was passed through. The skin was then closed in standard fashion with absorbable sutures and petroleum gauze was packed around the abutment and held in place by a plastic cap that was sutured into place. All patients received a 6 mm abutment.
For the Weber technique a 1.5 cm horizontal incision was made through the skin and subcutaneous tissue to the periosteum centered on the implant site ( Fig. 2 B ). The surrounding soft tissue and muscle were removed approximately 1 cm circumferentially ( Fig. 3 A ). The extent of soft tissue removal depended on the thickness of the scalp; patients with thicker skin required more extensive removal. The periosteum was then removed 4 mm surrounding the implant site and the titanium implant was drilled into place in the traditional fashion. The abutment was installed and the skin closed around it with absorbable sutures ( Fig. 3 B). Petroleum gauze and plastic cap were applied as described above ( Fig. 3 C). Originally a 6 mm abutment was used, however this has been replaced with a 9 mm abutment to help prevent skin overgrowth.
2
Materials and methods
A retrospective chart review was performed of all Baha® implantations by a single surgeon (MR) over a three-year period. This time period included patients in whom the implant was performed using an inverted J incision, and those performed with the new Weber technique (described below). Demographics, infection rate, time to activation, operative time, and subsequent procedures were included in the analysis. Demographics, operative time, time to activation, and follow up time were compared using a t-test, the Fisher’s exact test was used for complications.
Operative techniques
Both techniques were performed under local anesthesia with or without sedation in an outpatient surgical center. The site of the implant was marked 5 to 6 cm posteriosuperior to the EAC and an area of the surrounding scalp was shaved and prepped in standard sterile fashion. Local anesthetic was administered to areas of proposed incision and dissection.
For the ‘inverted-J’ technique a curvilinear incision was carried to the level of the periosteum to create an anteriorly based skin flap with approximately 2 cm of tissue between the incision and the implant site (Similar to Fig. 1 B ). The skin flap was thinned and the subcutaneous tissues removed. The periosteum was then removed 4 mm surrounding the implant site and the titanium implant was drilled into place in the traditional fashion. A punch was used to create a defect in the skin flap where the abutment was passed through. The skin was then closed in standard fashion with absorbable sutures and petroleum gauze was packed around the abutment and held in place by a plastic cap that was sutured into place. All patients received a 6 mm abutment.
For the Weber technique a 1.5 cm horizontal incision was made through the skin and subcutaneous tissue to the periosteum centered on the implant site ( Fig. 2 B ). The surrounding soft tissue and muscle were removed approximately 1 cm circumferentially ( Fig. 3 A ). The extent of soft tissue removal depended on the thickness of the scalp; patients with thicker skin required more extensive removal. The periosteum was then removed 4 mm surrounding the implant site and the titanium implant was drilled into place in the traditional fashion. The abutment was installed and the skin closed around it with absorbable sutures ( Fig. 3 B). Petroleum gauze and plastic cap were applied as described above ( Fig. 3 C). Originally a 6 mm abutment was used, however this has been replaced with a 9 mm abutment to help prevent skin overgrowth.
