Subperiosteal temporal pocket versus standard technique in cochlear implantation: a comparative clinical study.

OBJECTIVE: In the standard technique of cochlear implantation, the internal receiver-stimulator (IRS) is fixed into a socket drilled on the calvarial bone. In the subperiosteal technique, the IRS is fixed under the subperiosteal plane, and drilling is not necessary. The purpose of this study was to compare the subperiosteal and the standard techniques. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary referral center; cochlear implant program. PATIENTS: One hundred forty-eight patients who underwent cochlear implantation. INTERVENTION: The researcher who evaluated the patients was not informed which of the 2 techniques was used on the patients and administered a visual analog scale (VAS) analysis. The duration of the operation, intraoperative and postoperative complications, and migration of the IRS were assessed. MAIN OUTCOME MEASURES: A VAS survey was administered to the patients or to their parents to evaluate the practicability of the implant. RESULTS: The duration of the operation was 73.4 ± 17.8 minutes in the subperiosteal group and 105.5 ± 17.8 minutes in the standard technique group. The difference was statistically significant. Intracranial complications or migration of the IRS was also not observed in any patient. The VAS score was 4.2 ± 2.1 in the standard group and 4.3 ± 1.9 in the subperiosteal group. The difference was not statistically significant. CONCLUSION: The subperiosteal technique can be safely and effectively used in cochlear implantation. Not only are there no intracranial complications and no migration of IRS was observed but also the mean operation time is reduced up to 30% and none of the patients have reported difficulty with fixing of the external device.

Modified midfacial degloving approach for sinonasal tumors.

A perfect surgical approach to nasal cavity and paranasal sinus tumors should provide a broad exposition preserving the important structures with no cosmetic defect. Midfacial degloving (MD) technique provides good exposure without incisions and scars in the face. Classic MD technique includes rhinoplasty incisions. However, combination of the facial plastic skills of the rhinoplasty techniques with an oncologic approach limits its popularity. We modified the classic technique, which is performed without classic rhinoplasty incisions. The surgical approaches to 55 patients with benign and malignant sinonasal neoplasms are reviewed, and the modification of MD technique performed without rhinoplasty incisions is described. The study includes 41 male and 13 female patients with both benign and malignant sinonasal neoplasms. The ages of the patients were between 9 and 78 years with a mean age of 41.15 years. Follow-up of the patients ranged from 2 to 96 months with a mean of 31.7 months. Most of the cases were angiofibroma and inverted papilloma. Modified MD approach was used for all patients, and in 6 cases, the technique was combined with subcranial approach. We successfully resected the tumors in all of the patients. The most frequently encountered complaint in the postoperative period was temporary nasal crusting and epistaxis. An important complication was the rupture of subpetrous part of the internal carotid artery in one patient and also a temporary facial palsy in another one. Palatal dysfunction, oroantral fistula, or vestibular stenosis, which are significant complications of MD, were not observed in any of our cases. In this modified technique, rhinoplasty incisions are not used; therefore, the duration of operation is shortened, the technique becomes easier, and the incisions of the rhinoplasty procedure, which could cause circular stenosis, are avoided.