[Round window implantation of vibrant soundbridge through a retrofacial approach]

Objective:To investigate the specific retrofacial approach for application of vibrant soundbridge （VSB） to the round window （RW） in patients with complex congenital ear malformation. Methods:The clinical information of four patients with congenital ear malformation were retrospectively analyzed. VSB were implanted unilaterally in these four patients via a retrofacial approach. During the operation, it is difficult to reach the RW via a classic posterior tympanotomy pathway, due to the mastoid portion of FN positioned anteriorly severely. So the round window niche was identified through a retrofacial pathway and the round window vibroplasty was completed. Results:All four patients received the round window vibroplasty successfully via retrofacial approach. Satisfied auditory benefit were confirmed after surgery. Compared with the preoperative data, clear improvements in both hearing threshold and the speech discrimination score were confirmed after VSB activation. Neither intraoperative nor postoperative surgical complications was observed in all patients. Conclusion:During the round window vibroplasty, when it was unable to access the RW through the classic facial recess pathway due to the aberrant facial nerve， the retrofacial approach could be a valid and feasible alternative approach.