Single-Stage Ear Reconstruction Simultaneous With Piezoelectric Osia® Bone Conduction Implantation

Single-stage, alloplastic ear reconstruction is often met with the challenge of coordinating bone-anchored hearing aid implantation. Modern digital piezoelectric stimulation, such as the Cochlear™ Osia® System (Sydney, Australia), contains integrated circuitry preventing the use of monopolar cautery after implantation and is larger than other devices, thus presenting several surgical challenges during simultaneous implantation. This study presents the first series of patients outlining a stepwise technique for safe and effective single-stage ear reconstruction and Osia implantation. Furthermore, it highlights the advancing technologies in hearing restoration and navigation of ear reconstruction in coordination with these modern devices. A retrospective analysis of patients who underwent single-stage ear reconstruction using alloplastic implants with simultaneous implantation of an Osia piezoelectric hearing system was performed. Patient demographics, surgical techniques, and outcomes were assessed. A total of 8 patients meeting the above criteria were identified. The median patient age at the time of surgery was 8 years old. All but one patient presented with grade 3 microtia. The temproparietal fascial (TPF) flap was used for coverage of the alloplastic ear construct in 7 of the 8 cases with the occipital fascial (OF) flap used in the remaining case. Periauricular incisions were used in all TPF cases with an extension into an existing coronal incision for the OF patient. For Osia implant coverage, the pericranium was retained in all cases and raised as a separate, inferiorly based flap taking care to preserve the venous outflow to the ear reconstruction flaps. The average total surgery time was 9.3 hours with Osia implant placement consuming an average of 53 minutes. All Osia implants produced functional hearing, and there were no exposures of the Osia implants in this series. Single-stage alloplastic ear reconstruction with simultaneous implantation of the Osia piezoelectric implant is a safe and efficient method that provides the most advanced hearing restoration and an aesthetic microtia reconstruction. Craniofacial surgeons should maintain awareness of the advances in bone conduction technology and the implications regarding surgical approach and operative planning.