Percutaneous Bone Implant Surgery: A MIPS Modified Technique

Abstract

Since their introduction, passive percutaneous hearing aids have undergone substantial evolution, including changes in implant production, improvements in the sound processor, and simplification of surgical implantation techniques. The latest innovation comes from the minimally invasive technique proposed for the PONTO system (MIPS), which does not involve the creation of a mucoperiosteal flap in order to leave the surrounding soft tissue and vascular microcirculation intact. This study proposes a modified surgical technique compared to the one proposed for the PONTO system in order to overcome some steps of the traditional surgical technique for the placement of the Baha Connect prosthesis. Our technique does not involve any incision but the exposure of the periosteum using a skin punch and subsequent drilling without the use of any protective cannula. The described procedure allows one to overcome some steps of the traditional surgical technique and, consequently, also some post-operative complications. Moreover, a minimally invasive procedure can help reduce surgical time and the invasiveness of the application.

Keywords: bone; deafness; implants; percutaneous BCI.

FIGURE 1

Steps for the minimally invasive percutaneous surgery. (A) The implant placement point is identified 55 mm postero‐superior to the external auditory canal. (B) The thickness between the skin and the periosteum is measured using a Baha ruler. (C) A circular incision is made with a 5 mm biopsy punch. (D) A hole is created with a 3 mm conical burr. (E) The thickness of the hole is increased with a 4 mm conical burr. (F) With an enlarging bur a countersink is made to enlarge the hole diameter. (G) The screw is positioned in the previously created hole. (H) Check that the abutment is screwed in correctly with a torque spanner. (I) Place gauze and protective cap around the prosthesis as a dressing.

FIGURE 2

Post‐operative check‐up 1 month later.