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J Formos Med Assoc. 2019 Feb 20. pii: S0929-6646(18)30747-2. doi: 10.1016/j.jfma.2019.01.013. [Epub ahead of print]

Simultaneous auricular reconstruction and transcutaneous bone conduction device implantation in patients with microtia.

Author information

1
Division of Otology, Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
2
Craniofacial Research Center, Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
3
Division of Plastic and Reconstructive Surgery, Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong, China.
4
School of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
5
School of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: chenzc@adm.cgmh.org.tw.

Abstract

BACKGROUND/PURPOSE:

The Bonebridge (BB) is a newly designed transcutaneous bone conduction hearing implant. We describe, for the first time, simultaneous BB implantation and different surgical techniques of auricular reconstruction for microtia patients with aural atresia/stenosis.

METHODS:

Ten patients with unilateral or bilateral microtia underwent BB implantation combined simultaneously with either total auricular reconstruction using bespoke hand-carved Medpor framework or second stage auricular projection using autologous costal cartilage framework. Auditory aided and unaided sound fields were evaluated using (1) a pure-tone average (PTA4), (2) a speech reception threshold (SRT), and (3) a Speech Discrimination Score (SDS) at a sound level of 65 dB SPL.

RESULTS:

All patients and their families were satisfied with the aesthetic outcome of their constructed ears with no requests for further revision. No major complications were encountered. One patient developed minor partial skin graft epidermolysis that healed uneventfully, and another patient had a three month period of auditory acclimatization to the BB device that resolved. Postoperatively, the mean aided PTA4 decreased by 35.35 dB, while the SRT was 54.5 dB HL unaided and 28 dB HL with use of a BB sound processor. The SDS increased by 16.4%-65 dB SPL.

CONCLUSION:

Simultaneous BB implantation during either total auricular reconstruction or framework projection for microtia patients who have aural atresia/stenosis is feasible and safe. This approach reduces operative stages, thereby minimizing schooling/occupational disruption and time to total microtia reconstruction and auditory rehabilitation.

KEYWORDS:

Autologous costal cartilage; Combined approach; Medpor; Microtia reconstruction; Transcutaneous bone conduction hearing implant

PMID:
30797620
DOI:
10.1016/j.jfma.2019.01.013
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