An Easy to use Periosteal Flap for Cochlear Implantation: Experience from a Tertiary Care Centre
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CLINICAL REPORT
An Easy to use Periosteal Flap for Cochlear Implantation: Experience from a Tertiary Care Centre Naresh K. Panda1 • Neemu Hage1 • Roshan Kumar Verma1 • Jaimanti Bakshi1 Gyan Ranjan Nayak1 • Ramandeep S. Virk1
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Received: 24 September 2020 / Accepted: 3 November 2020 Ó Association of Otolaryngologists of India 2020
Abstract This report describes a novel and easy periosteal flap design for cochlear implantation. This technique has been used in 37 patients between June 2019 and August 2020. The patients have been followed up for a period of 2 months to 15 months. There were no flap related complications attributed to this flap. There was no wound hematoma, wound breakdown or implant migration. The flap design is safe, easy, less time consuming and results in better coverage of the receiver stimulator unit without any tension.
rates and improve surgical results. Keeping the above goals in sight, we have come up with a novel technique of simple and easy periosteal flap for the Surgeon. It utilizes a vertical curvilinear incision over the periosteum facilitating a wide exposure, minimal tissue handling and results in good healing. This flap has been successfully used in 37 cochlear implantations. Prior to the use of this flap we were using the anteriorly based Palva flap in all our cases (n = 199).
Method–Surgical Procedure Keywords Cochlear implants Periosteal flap Minimizing complications
Introduction Over the years the surgical techniques for cochlear implantation has witnessed various modifications each with its distinct advantage and contrived to enhance the surgical outcomes. Inspite of all relentless efforts, flap related complications in cochlear implantation still prevail. Farinetti et al. [1] in their review of 403 cochlear implantations reported 11 flap related issues. Cohen et al. [2] in a series of 459 implantations showed an incidence of 4.8% major complications, majority being flap related. Hence there are concerted efforts from the surgical teams to develop soft tissue handling techniques that would reduce explantation
& Naresh K. Panda [email protected] 1
Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
All the procedures are done under General anesthesia. The patient is placed supine with the head turned opposite to the side of the operation. A post auricular incision is made approximately 1.5 cms behind the retroauricular sulcus measuring around 3 cms long and stops superiorly just at the hairline and inferiorly at the mastoid tip. The skin flaps are raised at the subcutaneous level up to around 3 cms to expose the periosteum completely. Next a curvilinear periosteal incision is commenced from superior to inferior direction away from the skin incision line. The initial curvature of this incision is inclined more posteriorly. (Figs. 1 and 2). The incision over the periosteum then curves anteriorly up to the mastoid tip. The anterior periosteal flap is then raised up to the bony external audito
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