title: Minimally invasive approach and fixation of cochlear and middle ear implants.
abstract: One of the conventional surgical approaches for cochlear implantation is a retro-auricular incision with a posterior-inferiorly based skin and subcutaneous tissue flap and a superiorly based periosteal flap. The obvious advantage is an open operating field but the disadvantages are a large wound and a lengthy operating time. It may also result in more wound-related complications. To overcome these disadvantages, we have developed a minimally invasive technique that includes a small retro-auricular single layer incision. We have used a metal bridge beneath the posterior flap to increase accessibility when creating a recess for the implant. A novel technique is used to place the securing suture deep to the flap. This technique has been used in 49 paediatric and adult patients, and there have been no wound-related complications. Although this technique was initially designed for the CLARION CII implant, it has been used to place and secure the new CLARION HiRes 90 K, the Nucleus device, the MEDEL device and the Vibrant Soundbridge.
authors.affiliation: Auditory Implant Centre, Department of Otolaryngology, Head and Neck Surgery, Guy's and St Thomas Hospitals, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Jiang
authors.forename: A
authors.initials: A
authors.lastname: Bibas
authors.forename: A Fitzgerald
authors.initials: AF
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D002648:Child; D019929:Cochlear Implantation; D004432:Ear, Middle / Q000601:surgery*; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D019919:Prosthesis Implantation; D013524:Surgical Flaps