title: Minimally invasive cochlear implantation with mastoidal three-layer flap technique.
abstract: OBJECTIVE
  To describe and evaluate a minimally invasive cochlear implantation approach using mastoidal three-layer flap (TLF) technique.
  
  
  METHODS
  We conducted a prospective clinical study at a tertiary referral center. The study population comprised 32 males and 16 females, with an age range of 1-51 years. Thirty-nine patients were operated on using the TLF technique and 9 patients were operated on using a classical cochlear implantation technique. The TLF technique was based on using the superficial musculoaponeurotic system (SMAS) as an additional, strong flap layer. The TLF, with 3 different pedicules, comprised an anteriorly based 4-cm skin flap, a superiorly based temporomastoidal flap, which included the SMAS, and an anteriorly based periostal Palva type flap in the same mastoidal area.
  
  
  RESULTS
  No major complications, including flap-wound problems and receiver-stimulator migration or extrusion, were encountered. The mean operation time was 66 min in the TLF population and 92 min in the classical operation population, which shows a statistically significant difference noted in the time of operation (p = 0.0001).
  
  
  CONCLUSIONS
  The TLF cochlear implantation enables complete receiver-stimulator coverage and safe fixation without any additional procedures, while allowing reduced operation time.
authors.affiliation: Otolaryngology Department, Istanbul Medical Faculty, Istanbul University, TR-34390 Capa, Istanbul, Turkey. ulugt@ttmail.com
authors.forename: Tuncay
authors.initials: T
authors.lastname: Ulug
authors.forename: Aysenur Meric
authors.initials: AM
authors.lastname: Teker
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D013524:Surgical Flaps; D055815:Young Adult