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Single Vertical Incision for BAHA: Preliminary Results
Scientific Oral Presentations
Simulator Enhances Drilling Skills in Inexperienced Surgeons Ravi N Samy, MD (presenter); Shanmugam Murugappan, PhD; Don Stredney, BS, MA; Gregory Wiet, MD, MBS OBJECTIVE: 1) Validate whether a PC-based simulation program can be used to enhance temporal bone skills in those without any anatomical knowledge or surgical experience. 2) Understand the complexities of adapting simulator technology to educate novice and experienced temporal bone surgeons. METHODS: In this prospective, pilot study, individuals performed a craniectomy (measuring approximately 1”x2”) from the squamosa of cadaveric temporal bone specimens using typical otologic drills and instrumentation; the goals were to remove the bone, create straight lines along the edges of the craniectomy, and perform dural decompression without violating the dura. After performing this, the individuals then spent the next 2 weeks performing virtual temporal bone surgery on the OSC/OSU simulator. The individuals then performed the craniectomy a second time. A blinded observer (neurotologist) then assessed performance on the pre- and post-simulation tested bones. RESULTS: In all 6 sets of bones (12 bones total), the blinded observer was able to correctly determine which was the presimulation temporal bone and the post-simulation temporal bone. This was based primarily on the objective criteria of adequacy of dural decompression and the avoidance of dural tears. The assessment of linear edges of the craniectomy was not felt to be of sufficient importance. CONCLUSIONS: The temporal bone simulator was able to improve the surgical skills in individuals with no prior temporal bone surgical experience or anatomy knowledge. The preliminary data from this study will be extended to a larger study group for statistical significance. Additional performance measures will need to be created to improve objective evaluation.
Single Vertical Incision for BAHA: Preliminary Results Eric P Wilkinson, MD (presenter); William M Luxford, MD; John W House, MD; Antonio De la Cruz, MD; William H Slattery, III, MD; Jose N Fayad, MD OBJECTIVE: A single vertical skin incision with subcutaneous tissue undermining is a cosmetic alternative to standard dermatome skin graft elevation for bone anchored hearing aid (BAHA) placement. A vertical incision minimizes alopecia and simplifies wound closure, while maintaining thin skin flaps. We aimed to determine the preliminary complication rate using a 4cm skin inicsion with 4X4 cm of subcutaneous tissue removal. METHODS: A retrospective chart review of patients undergoing BAHA placement from January 2006 to August 2007 was performed. This search was filtered to include only vertical incision BAHA patients. Complications including skin irritation or infection, skin overgrowth, and implant extrusion were tallied. Pertinent patient risk factors were identified. 71 patients underwent vertical incision surgery, with a mean followup time of 6.8 months. 50 patients had sensorineural hearing losses and 21 had conductive hearing losses. RESULTS: No patient had spontaneous extrusion of the titanium abutment. There were 5 minor complications (skin irritation 3, wound infection requiring oral antibiotics 1, postoperative hematoma 1) and 7 major complications (irritation requiring abutment removal 1, skin overgrowth or infection requiring flap revision 6). Total complication rate was 16% and major complication rate was 9.8%. CONCLUSIONS: A single vertical incision for BAHA placement has a similar complication rate to traditional dermatome use in this preliminary study, though more follow-up is necessary to identify cases of late skin overgrowth. Patients with thick scalps or risk factors for hypertrophic scarring may require placement of longer abutments. Surgical Treatment of Tympanic Membrane Retractions Venkat R Srinivasan, FRCS (ORL) (presenter); Mihirangi Shamane Rubasinghe, MBBS, MS; Christopher Low, MBChB, MRCS OBJECTIVE: To report a modified technique of cartilage reinforcement tympanoplasty. To assess the safety and efficacy of this technique for symptomatic tympanic membrane retractions. METHODS: Retrospective analysis of patients with Pars Tensa retractions treated surgically between 2001 and 2007. The indications were discharge and hearing loss. Surgery involved excision of retracted segment, exposure of facial recess, removal of keratin and reinforcement with thinned tragal cartilage graft (cartilage thinned by cartilage cutter) and tempo-
SCI. ORALS
resolution were recorded at one week. The Dix-Hallpike maneuver was used to measure objective resolution at one week. Patient outcome using the device was compared with retrospective physician guided controls (n⫽40) using a Chi squared test. RESULTS: All patients reported being able to use and understand the device. 100% of patients in the prospective cohort reported either a cure or some improvement. At one week, 90% of these patients had a negative Dix-Hallpike test. This rate was comparable to that of the standard physician-guided treatment group who had a success of 83%. A significant difference in success between groups was not demonstrated (p⫽0.174). CONCLUSIONS: The use of this new device enabled patients to conduct an effective PRM on their own without physician training and to achieve success rates similar to those of an otolaryngologist.
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Simulator Enhances Drilling Skills in Inexperienced Surgeons Ravi N Samy, MD (presenter); Shanmugam Murugappan, PhD; Don Stredney, BS, MA; Gregory Wiet, MD, MBS OBJECTIVE: 1) Validate whether a PC-based simulation program can be used to enhance temporal bone skills in those without any anatomical knowledge or surgical experience. 2) Understand the complexities of adapting simulator technology to educate novice and experienced temporal bone surgeons. METHODS: In this prospective, pilot study, individuals performed a craniectomy (measuring approximately 1”x2”) from the squamosa of cadaveric temporal bone specimens using typical otologic drills and instrumentation; the goals were to remove the bone, create straight lines along the edges of the craniectomy, and perform dural decompression without violating the dura. After performing this, the individuals then spent the next 2 weeks performing virtual temporal bone surgery on the OSC/OSU simulator. The individuals then performed the craniectomy a second time. A blinded observer (neurotologist) then assessed performance on the pre- and post-simulation tested bones. RESULTS: In all 6 sets of bones (12 bones total), the blinded observer was able to correctly determine which was the presimulation temporal bone and the post-simulation temporal bone. This was based primarily on the objective criteria of adequacy of dural decompression and the avoidance of dural tears. The assessment of linear edges of the craniectomy was not felt to be of sufficient importance. CONCLUSIONS: The temporal bone simulator was able to improve the surgical skills in individuals with no prior temporal bone surgical experience or anatomy knowledge. The preliminary data from this study will be extended to a larger study group for statistical significance. Additional performance measures will need to be created to improve objective evaluation.
Single Vertical Incision for BAHA: Preliminary Results Eric P Wilkinson, MD (presenter); William M Luxford, MD; John W House, MD; Antonio De la Cruz, MD; William H Slattery, III, MD; Jose N Fayad, MD OBJECTIVE: A single vertical skin incision with subcutaneous tissue undermining is a cosmetic alternative to standard dermatome skin graft elevation for bone anchored hearing aid (BAHA) placement. A vertical incision minimizes alopecia and simplifies wound closure, while maintaining thin skin flaps. We aimed to determine the preliminary complication rate using a 4cm skin inicsion with 4X4 cm of subcutaneous tissue removal. METHODS: A retrospective chart review of patients undergoing BAHA placement from January 2006 to August 2007 was performed. This search was filtered to include only vertical incision BAHA patients. Complications including skin irritation or infection, skin overgrowth, and implant extrusion were tallied. Pertinent patient risk factors were identified. 71 patients underwent vertical incision surgery, with a mean followup time of 6.8 months. 50 patients had sensorineural hearing losses and 21 had conductive hearing losses. RESULTS: No patient had spontaneous extrusion of the titanium abutment. There were 5 minor complications (skin irritation 3, wound infection requiring oral antibiotics 1, postoperative hematoma 1) and 7 major complications (irritation requiring abutment removal 1, skin overgrowth or infection requiring flap revision 6). Total complication rate was 16% and major complication rate was 9.8%. CONCLUSIONS: A single vertical incision for BAHA placement has a similar complication rate to traditional dermatome use in this preliminary study, though more follow-up is necessary to identify cases of late skin overgrowth. Patients with thick scalps or risk factors for hypertrophic scarring may require placement of longer abutments. Surgical Treatment of Tympanic Membrane Retractions Venkat R Srinivasan, FRCS (ORL) (presenter); Mihirangi Shamane Rubasinghe, MBBS, MS; Christopher Low, MBChB, MRCS OBJECTIVE: To report a modified technique of cartilage reinforcement tympanoplasty. To assess the safety and efficacy of this technique for symptomatic tympanic membrane retractions. METHODS: Retrospective analysis of patients with Pars Tensa retractions treated surgically between 2001 and 2007. The indications were discharge and hearing loss. Surgery involved excision of retracted segment, exposure of facial recess, removal of keratin and reinforcement with thinned tragal cartilage graft (cartilage thinned by cartilage cutter) and tempo-
SCI. ORALS
resolution were recorded at one week. The Dix-Hallpike maneuver was used to measure objective resolution at one week. Patient outcome using the device was compared with retrospective physician guided controls (n⫽40) using a Chi squared test. RESULTS: All patients reported being able to use and understand the device. 100% of patients in the prospective cohort reported either a cure or some improvement. At one week, 90% of these patients had a negative Dix-Hallpike test. This rate was comparable to that of the standard physician-guided treatment group who had a success of 83%. A significant difference in success between groups was not demonstrated (p⫽0.174). CONCLUSIONS: The use of this new device enabled patients to conduct an effective PRM on their own without physician training and to achieve success rates similar to those of an otolaryngologist.
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