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

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.

A modified supra-auricular approach with helix cartilage suture for surgical treatment of the preauricular sinus.

OBJECTIVE: Several surgical techniques and modifications have been described to reduce the high recurrence rate after excision of preauricular sinus (PAS). This study was designed to evaluate the surgical outcomes of PAS excision using a new modified supra-auricular approach (SAA) and to assess the predisposing factors for recurrence. METHODS: A total of 175 (158 patients) PAS excision procedures were performed from 2007 to 2016 in a single institute using this modified SAA with helix cartilage suture to obliterate the dead space. The specimens were assessed to measure the closest distance between the squamous tract and the excised auricular cartilage (sinocartilaginous distance). We also evaluated the surgical outcomes and investigated the predisposing factors for recurrence, including gender, lesion laterality, etiology (primary or revised), anesthesia methods (general or local), history of infection, and history of incision and drainage (I&D) for abscess. RESULTS: Patients were followed up for a median duration of 45 months (range from 6 months to 10 years). There was a 2.3% (4 ears) recurrence rate and a 1.7% (3 ears) complication rate in our series. The average sinocartilaginous distance was 0.44 mm (median distance, 0.3 mm) and this value was less than 0.5 mm in 66% of cases. Recurrence was not significantly affected by gender, lesion laterality, etiology of surgery, anesthesia method, or a history of infection or preoperative I&D for abscess. CONCLUSIONS: Surgical PAS excision using the modified SAA with cartilage suture of dead space yielded low overall recurrence and complication rates in this series. Cosmesis was maintained due to a smaller incision. No significant predisposing factors for recurrence were identified. Thus, the modified technique described in the present study can be regarded as a simple, effective and reproducible surgical treatment for PAS.