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Implant-Retained Auricular Prosthesis: Is Mastoid Cell Perforation Associated With Implant Survival?
Matthias Ureel1, Valerie Van Kelecom2, Benjamin Denoiseux1
1Attending Physician, Department of Oral and Craniomaxillofacial Surgery, Ghent University Hospital, Ghent, East-Flanders, Belgium; Attending Physician, Cancer Research Institute Ghent, Ghent, East-Flanders, Belgium.
Background:
Implant-retained auricular prostheses are a well-established reconstructive option for patients with facial defects resulting from congenital anomalies, trauma, or oncologic resections. Most temporal implants are 3.0 to 4.0 mm in length. Longer implants could result in improved implant survival, but risk mastoid cell perforation.
Purpose:
The study purpose was to measure the association of implant mastoid cell perforation and implant survival.
Study Design, Setting, Sample:
A retrospective cohort study was conducted, including all patients treated with temporal endosseous implants at the University Hospital of Ghent between January 1, 1994, and July 31, 2024, with at least 1 postoperative computed tomography scan and minimal follow-up of 1 postoperative consultation. Patients were excluded if the available computed tomography scans were of insufficient quality or if patients were lost to follow-up.
Predictor Variable:
The predictor variable was temporal implant perforation into the mastoid air cells, coded as yes or no.
Outcome Variable:
The outcome variable was implant survival defined as the time between implant placement and implant loss, implant removal, or last consultation.
Covariates:
The covariates were age, sex, smoking, diabetes, radiotherapy, and reason of deformity.
Analysis:
Cox proportional hazards regression analyses were performed to assess the association between implant perforation into the mastoid air cells and implant survival, accounting for clustering of multiple implants within the same subject. A significance level of P ≤ .05 was considered statistically significant.
Results:
The sample was composed of 22 subjects, with a mean age of 50 years (range 10 to 93, SD 24), of which 16 subjects were (73%) males. A total of 46 implants were placed, of which 10 (22%) implants failed, resulting in a 1-year survival rate of 87% (95% CI, 85 to 88%). The median follow-up was 21 months (interquartile range = 108.5). No association was found between mastoid cell perforation and implant survival (hazard ratio 0.31; 95% CI, 0.06 to 1.60; P = .2). Higher age was associated with an increased risk of implant failure over time (hazard ratio 1.10; 95% CI, 1.03 to 1.17; P = .006).
Conclusion:
Mastoid air cell perforation showed no statistically significant association with implant survival. Larger prospective studies are needed to verify this result.
