An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 14 , ISSUE 1 ( January-April, 2022 ) > List of Articles

CASE REPORT

Management of Exposed Cochlear Implants: A Report of Two Cases

Vasanthi Anand, Sandhya Balasubramanyan, Lakshmi Shantharam

Keywords : Cochlear implantation, Device exposure, Major complication, Temporalis fascial flap

Citation Information : Anand V, Balasubramanyan S, Shantharam L. Management of Exposed Cochlear Implants: A Report of Two Cases. Int J Otorhinolaryngol Clin 2022; 14 (1):38-41.

DOI: 10.5005/jp-journals-10003-1421

License: CC BY-NC 4.0

Published Online: 22-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: There are several major and minor complications experienced by cochlear implant surgeons. Skin flap complication leading to exposure of the device is a major complication and can lead to explantation. In this article, we discuss about two cases where the implants were exposed, and the devices were successfully covered by flap rotation surgery. Background: Two patients experienced major skin flap complication (MSFC) after a trauma and followed by local site hematoma. The receiver stimulator was exposed. The infection was controlled. The exposed receiver-stimulator was covered with temporalis facial flap and scalp rotation. Case description: Case 1: The child had undergone cochlear implantation 2 years prior to presentation. The child had a head injury while playing that resulted in hematoma. It later got infected resulting in wound dehiscence and exposure of the device. Case 2: This implantee developed a small abscess near receiver stimulator 2 months after the surgery. Flap necrosis led to the devise getting exposed. In both the cases, double layer of temporalis fascia and skin flap rotation surgery was done. Conclusion: MSFCs can lead to exposed device. The device can be salvaged by two layers of vascularized temporalis facia with skin flap. This way it is possible to save the device avoiding explantation. Clinical significance: Every cochlear implant surgeon must know how to handle complications. The temporalis fascial graft is a good workhorse for covering the exposed device.


PDF Share
  1. Kiratzidis T, Arnold W, Iliades T. Veria operation updated I. The trans-canal wall cochlear implantation. ORL J Otorhinolaryngol Relat Spec 2002;64(6):406–412. DOI: 10.1159/000067578.
  2. Sanna M, Free R, Merkus P, et al. Complications and revision surgery in cochlear implantation. In: Surgery for cochlear and other auditory implants. Stuttgart: Thieme 2012. DOI: 10.1097/MAO.0b013e3182a09b54.
  3. Farinetti A, Ben Gharbia D, Mancini J, et al. Cochlear implant complications in 403 patients: comparative study of adults and children and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2014;131(3):177–182. DOI: 10.1016/j.anorl.2013.05.005.
  4. Karamert R, Mehmet D, Hakan T, et al. Assessment of cochlear implant revision surgeries in a cohort of 802 patients. Otol Neurotol 2019;40(4):464. DOI: 10.1097/MAO.0000000000002152.
  5. Dagkiran M, Tarkan O, Surmelioglu O, et al. Management of complications in 1452 pediatric and adult cochlear implantations. Turk Arch Otorhinolaryngol 2020;58(1):16–23. DOI: 10.5152/tao.2020.5025.
  6. Gawęcki W, Karlik M, Borucki Ł, et al. Skin flap complications after cochlear implantations. Eur Arch Otorhinolaryngol 2016;273(12): 4175–4183. DOI: 10.1007/s00405-016-4107-1.
  7. Leach J, Kruger P, Roland P. Rescuing the imperiled cochlear implant: a report of four cases. Otol Neurotol 2005;26(1):27–33. DOI: 10.1097/00129492-200501000-00006.
  8. Gluth MB, Singh R, Atlas MD. Prevention and management of cochlear implant infections. Cochlear Implants Int 2011;12(4):223–227. DOI: 10.1179/146701011X12950038111576.
  9. Tan KJ, Lim CT, Lim AY. The use of muscle flaps in the salvage of infected exposed implants for internal fixation. J Bone Jt Surg Br 2010;92(3):401–405. DOI: 10.1302/0301-620X.92B3.22115.
  10. Leonhard L, Roche J, Wieland A, et al. The temporoparietal fascia flap is an effective strategy for cochlear implant wound coverage. Ann Otol Rhinol Laryngol 2020;129(2):135–141. DOI: 10.1177/0003489419877429.
  11. Eun SC, Kim SY, Kim CS, et al. Temporalis myofascial flap coverage for extrusion of internal device after cochlear implantation. Int J Pediatr Otorhinolaryngol 2016;91:124–127. DOI: 10.1016/j.ijporl.2016.10.023.
  12. Gawęcki W, Karlik M, Borucki Ł, et al. Skin flap complications after cochlear implantations. Eur Arch Otorhinolaryngol 2016;273(12): 4175–4183. DOI: 10.1007/s00405-016-4107-1.
  13. Beckenstein MS, Steenerson RL, Elliott LF, et al. Use of a superficial temporal fascia flap for coverage of an exposed cochlear implant. Otolaryngol Head Neck Surg 1999;120(6):940–942. DOI: 10.1016/S0194-5998(99)70343-8.
  14. Lima Sánchez JS, Berenguer B, Aránguez G, et al. Extruded cochlear implant magnet covered with a temporoparietal fascial flap. A case report E. Cir Pediatr 2013;26(1):48–51. PMID: 23833928.
  15. Jaquet Y, Higgins KM, Enepekides DJ. The temporoparietal fascia flap: a versatile tool in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2011;19(4):235–241. DOI: 10.1097/MOO.0b013e328347f87a.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.