|
Problem | When | Suggested technique |
|
Superficial course of facial nerve | At incision | Less pressure on the knife and more superior incision. |
Bilateral “symmetrical” position of the implant | At incision | Drawing of the position of the implant on a blueprint and copy at the contralateral side (Figure 3). |
Profuse bleeding because of bone marrow filled mastoid | During mastoidectomy | Use diamond burrs and close off the mastoid cells with bone wax. |
“Thick” implant and thin skull cortex | During creation of the implant bed | Create a bony island over the dura (Figure 4). |
Round window in a more horizontal plane | Before cochleostomy | Make the posterior tympanotomy as wide as possible, and drill towards stapes to find round window. |
Ossification of the cochlea | At cochleostomy and electrode insertion | Drill-out of basal turn of the cochlea, partial electrode insertion, scala vestibuli insertion, or split electrode insertion. |
Hematoma at the first implanted ear | At closure of first side | Place surgical drain superficial of the musculoperiosteal flap, remove after head bandage. |
Electrode can dislocate out of the cochlea | During development of the mastoid process | Position and fixation of the electrode lead in the round window, posterior tympanotomy, but not in the mastoid tip region. Ensure there is enough lead on the electrode to allow for development of temporal bone. |
|