[Cochlear implantation through retro-facial approach with congenital microtia malformation with facial nerve deformity: a case report]

Xinyue Zou ¹, Shujin Xue ¹, Xingmei Wei ¹

⁰Department of Otorhinolaryngology Head and Neck Surgery，Beijing Tongren Hospital，Capital Medical University，Beijing，100730，China.

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi = Journal of Clinical Otorhinolaryngology Head and Neck Surgery +

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April 30, 2024

View abstract on PubMed

Summary

Cochlear implantation in patients with congenital microtia and facial nerve malformations can be challenging. The retro-facial approach is a feasible surgical option, ensuring no facial nerve injury and good auditory outcomes.

Area Of Science

Otorhinolaryngology
Neurosurgery
Medical Imaging

Background

Congenital microtia presents challenges for cochlear implantation due to altered anatomy and potential facial nerve malformations.
Facial nerve malformations, including bony cover loss, aberrant position, or bifurcation, complicate surgical approaches and increase risks.

Purpose Of The Study

To describe a case of cochlear implantation in a patient with congenital microtia and facial nerve malformation.
To evaluate the efficacy and safety of the retro-facial approach in such complex cases.
To highlight the importance of pre-operative imaging and intra-operative monitoring for facial nerve preservation.

Main Methods

A case study of a patient with profound sensorineural hearing loss due to facial nerve malformation.
Cochlear implantation performed using the retro-facial approach.
Post-operative assessment including auditory performance (CAP) and speech intelligibility (SIR) questionnaires, and monitoring for facial nerve function.

Main Results

The retro-facial approach successfully facilitated cochlear implantation without compromising facial nerve integrity.
The patient exhibited no signs of facial paralysis or spasm 2 years post-surgery.
Good functional outcomes were reported, with CAP score of 7 and SIR score of 4.

Conclusions

The retro-facial approach is a viable alternative when the facial recess approach is obstructed in patients with facial nerve malformations.
Pre-operative thin-section CT scans and intra-operative facial nerve monitoring are crucial for preventing nerve injury.
This approach offers a safe and effective solution for cochlear implantation in complex microtia cases.

Keywords:

cochlear implant facial nerve malformation microtia retro-facial approach