AUTHOR=Strijbos Ruben M. , Straatman Louise V. , Calon Tim G. A. , Johansson Martin L. , de Bruijn Arthur J. G. , van den Berge Herbert , Wagenaar Mariette , Eichhorn Edwin , Janssen Miranda , Jonhede Sofia , van Tongeren Joost , Holmberg Marcus , Stokroos Robert 

TITLE=Long-Term Outcomes of the Minimally Invasive Ponto Surgery vs. Linear Incision Technique With Soft Tissue Preservation for Installation of Percutaneous Bone Conduction Devices

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.632987

DOI=10.3389/fneur.2021.632987

ISSN=1664-2295

ABSTRACT=Objective: A comparison of the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with the linear incision technique with soft-tissue preservation (LITT-P) for bone conduction devices after a follow-up of 22 months.
Methods: In this multicentre randomised controlled trial, there was inclusion of sixty-four adult patients eligible for unilateral surgery. There was 1:1 randomization to the MIPS (test) or the LITT-P (control) group. Primary outcome was (adverse) soft tissue reaction. Secondary outcomes were pain, loss of sensibility, soft tissue height/overgrowth, skin sagging, implant loss, Implant Stability Quotient (ISQ) measurements, cosmetic scores and quality of life questionnaires.
Results: Sixty-three subjects were analysed in the intention-to-treat population. No differences were found in the presence of (adverse) soft tissue reactions during complete follow-up. Also, there were no differences in pain, wound dehiscence, skin level, soft tissue overgrowth and overall quality of life. Loss of sensibility (until three months post-surgery), cosmetic scores and skin sagging outcomes were better in the MIPS group. The ISQ was higher after the LITT-P for different abutment lengths at various points of follow-up. Implant extrusion was non-significantly higher after the MIPS (15.2 %) compared to LITT-P (3.3 %). 
Conclusion: The long-term results show favourable outcomes for both techniques. The MIPS is a promising technique with some benefits over the LITT-P. Concerns regarding non-significantly higher implant loss may be overcome with future developments and research.