Patricia L Purcell1, Hedyeh Ziai1, Josie Xu1, Karen A Gordon1,2,3,4, Blake C Papsin1,2,3, Sharon L Cushing1,2,3. 1. Department of Otolaryngology, Head & Neck Surgery. 2. Archie's Cochlear Implant Laboratory. 3. Institute of Medical Science, University of Toronto. 4. Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: This study examines the incidence and management of traumatic loss or osseointegration failure of percutaneous bone conduction implants in children. STUDY DESIGN: Case series. SETTING: Pediatric tertiary care institution. PATIENTS: Children who underwent percutaneous osseointegrated implant placement from 1996 to 2016. INTERVENTIONS: Clinical evaluation and revision surgery after implant loss. MAIN OUTCOME MEASURES: This study compares the characteristics of children who experienced traumatic loss of implant to those who did not to calculate odds ratios (ORs) describing the risk of injury and investigate device utilization after implant failure. RESULTS: One hundred forty-seven children received percutaneous bone conduction devices; 129 were followed for at least 1 year. Trauma occurred in 19 of 129 cases (15%). Among children with traumatic injury, mean age at initial surgery was 5 years (SD = ±3.3), and 42% had a developmental delay. Among children without traumatic injury, mean age at initial surgery was 6.5 years (SD = ±4.4), and 28% had a developmental delay. Multivariate logistic regression found no significant differences in age, sex, or developmental delay associated with implant loss. In five of 19 traumatic cases (26%), the implant remained in situ due to either skull fracture or abutment loss. In the remaining 14 of 19 cases (74%), there was osseointegration failure with extrusion of the implant. Seventeen children underwent revision surgery utilizing previously placed "sleeper," or backup, osseointegrated implant, and 14 (82%) of these continued to use their device. Two patients with extruded implants did not undergo revision surgery. CONCLUSION: Traumatic injury or osseointegration failure leads to loss of percutaneous bone conduction implants in approximately 15% of children. Revision surgery is often successful.
OBJECTIVE: This study examines the incidence and management of traumatic loss or osseointegration failure of percutaneous bone conduction implants in children. STUDY DESIGN: Case series. SETTING: Pediatric tertiary care institution. PATIENTS: Children who underwent percutaneous osseointegrated implant placement from 1996 to 2016. INTERVENTIONS: Clinical evaluation and revision surgery after implant loss. MAIN OUTCOME MEASURES: This study compares the characteristics of children who experienced traumatic loss of implant to those who did not to calculate odds ratios (ORs) describing the risk of injury and investigate device utilization after implant failure. RESULTS: One hundred forty-seven children received percutaneous bone conduction devices; 129 were followed for at least 1 year. Trauma occurred in 19 of 129 cases (15%). Among children with traumatic injury, mean age at initial surgery was 5 years (SD = ±3.3), and 42% had a developmental delay. Among children without traumatic injury, mean age at initial surgery was 6.5 years (SD = ±4.4), and 28% had a developmental delay. Multivariate logistic regression found no significant differences in age, sex, or developmental delay associated with implant loss. In five of 19 traumatic cases (26%), the implant remained in situ due to either skull fracture or abutment loss. In the remaining 14 of 19 cases (74%), there was osseointegration failure with extrusion of the implant. Seventeen children underwent revision surgery utilizing previously placed "sleeper," or backup, osseointegrated implant, and 14 (82%) of these continued to use their device. Two patients with extruded implants did not undergo revision surgery. CONCLUSION:Traumatic injury or osseointegration failure leads to loss of percutaneous bone conduction implants in approximately 15% of children. Revision surgery is often successful.