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Clinical outcome of the simplified surgical technique for BAHA implantation
Maarten J F de Wolf1, Myrthe K S Hol, Patrick L M Huygen
1Department of Otorhinolaryngology, Donders Centre of Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Objective:
To evaluate the clinical outcome of a simplified surgical technique for BAHA implantation, in terms of implant failure and its causes.
Design:
Retrospective analysis.
Methods:
Analysis of a consecutive cohort of 142 patients (150 loaded implants) fitted with the BAHA implant between January 1, 1997, and December 31, 1999. The simplified surgical Nijmegen technique comprises a longitudinal postauricular incision, extensive subcutaneous tissue reduction, and removal of the periosteum. Clinical outcomes were the rate of implant failures, its causes for this, and skin reactions around the percutaneous implants classified according to Holgers. Clinical results were compared with other BAHA series.
Results:
Mean follow-up was 5.6 +/- 2.7 years (range, 0-10.5 yr). Holgers grade 2 or more severe skin reactions were seen in 6.5% of the 1,038 follow-up visits. Extrusion of the implants occurred as a result of failed osseointegration (n = 3), trauma (n = 5), infection (n = 1), and (other) medical reasons (n = 5 explanations). Total extrusion rate was 9.3%. Only 3% (1 and 3) were due to failed osseointegration or infection around the percutaneous implant.
Conclusion:
The modified Nijmegen surgical technique is a simple straightforward surgical procedure without the use of a pedicled skin flap. Surgery takes approximately 20 minutes. Meticulous performance of the procedure is considered important to achieve optimal results in the long-term. Particularly the soft tissue reduction has to be done with great care. In terms of the low rates of implant failure and adverse tissue reactions, the Nijmegen surgical technique proved to be a good alternative to other techniques.
