The Cleating Stitch: An Adjunctive Technique for Percutaneous and Revision Osseointegration Screws.

OBJECTIVE: The bone anchored hearing aid (BAHA) has become a widely used and successful option in treatment of conductive and mixed hearing loss, and single sided deafness. Despite improvements in technique and cosmesis, complications remain that can result in implant revision or removal. Herein we describe a unique adjunctive technique, the cleating stitch, in placement of osseointegration screws and examine its impact on complication rates. STUDY DESIGN: Retrospective case review. SETTING: Tertiary academic medical center. PATIENTS: A total of 66 implants in 65 patients (35 men, 30 women) with an average age of 54 years (15-81 yr). Average follow up 10.8 months. INTERVENTION: All patients underwent BAHA implant placement by a single surgeon between April 2012 and June 2017 using the linear incision or punch techniques with soft tissue reduction and placement of a cleating stitch. MAIN OUTCOME MEASURE: Main outcome measures include rates of revision surgery, overgrowth, extrusion, and Holgers reaction ≥2. Secondary outcome measures include associations between main outcome measures and outlying factors (obesity, smoking, diabetes mellitus, coronary artery disease, age). RESULTS: The overall rate of revision was 3%, rate of overgrowth 1.5%, rate of extrusion 1.5%, and Holgers reaction ≥2 10.6%. Overgrowth and extrusion both required revision. Older age was associated with decreased risk of Holgers reaction ≥2 (p = 0.03) with a hazard ratio of 0.95 (confidence interval 0.9-1.0). There were no other statistically significant associations between primary outcome measures and outlying factors. CONCLUSION: The cleating stitch is an effective adjunctive technique in placement of osseointegration screws associated with low rates of overgrowth and overall revision surgery.

Squamous cell carcinoma of the tonsil masquerading as a peritonsillar abscess.

A 58-year-old man presented to the emergency department with a persistent left-sided sore throat of 2-month duration. The sore throat had not responded to antibiotic therapy. Over the past week, the soreness had increased and was aggravated by opening the mouth. He denied fever but admitted to a 10-lb weight loss. His social history was significant for alcohol and tobacco use. Physical examination revealed a bulging and erythematous left soft palate with a deviated uvula. Areas of the tonsil were noted to be ulcerating through the soft palate. In the upper left neck, a 3-cm, firm, nontender, lymph node was palpated anterior to the sternocleidomastoid muscle. A computed tomography of the neck with contrast revealed an enhancing tonsillar mass as well as enlarged lymph nodes bilaterally. A transoral biopsy returned squamous cell carcinoma.