SYNCHRONY PIN Cochlear Implant Surgical Guidelines

MED-EL PIN Implants.

The following medical illustrations are schematic

and can differ from a patient's anatomical situation for demonstration purposes.

Please refer to MED-EL surgical guidelines for more information.

Step 1: Preparation for implant placement.

After the area is sterile place the processor template behind the ear

and position the single-use implant template "PIN".

The lower part of the stimulator should be under or close to the temporal line

with an angle between 30 and 60 degrees.

Mark the correct position of the implant on the skin around the rim of the template

including the electrode lead exit

Create incision behind the pinna.

A small incision of three centimeters can be performed for all pin implants.

Step 2: Preparation for implant fixation.

A tight subperiosteal pocket can be achieved

by using the fingertips to feel the tip of the raspatory at the rim.

Measure the skin flap thickness with the skin flap gauge 6.

For optimal magnet attraction and signal transmission the flap should loosely fit in the gauge.

Reducing the skin flap thickness at the coil is recommended

when the flap exceeds six millimeters.

Check the size and position of the periosteal pocket with the implant template "PIN".

Mark the stimulator housing of the implant template rim and the electrode lead exit.

The distance between the stimulator housing and mastoid cavity

shall be approximately 10 to 15 millimeters.

The temporal bone area must be flattened to ensure sufficient stimulator immobilization.

Drill a two millimeter deep boney channel or trough for the electrode lead

to protect it against post-operative mechanical damage.

Step 3: PIN implants.

SYNCHRONY PIN cochlear implant is suitable for minimal incision approach.

It requires less drilling and is designed to provide fast and reliable fixation.

The pins are one millimeter in diameter and 1.4 millimeters in depth.

Use the PIN drill guide SI to check the flat surface

and use a one millimeter diamond bur to mark the pin holes.

There is no need to drill perpendicularly.

Removed the drilling template and enlarge the pin holes.

Insert the implant template "PIN" to double check for correct position of the implant.

Step 4: Implant placement and electrode insertion.

After the round window or cochleostomy site has been prepared,

insert the implant under the skin and align the two pins to the pin holes.

Palpate the implant through the skin to check for proper implant fixation.

The PIN implant together with a tight subperiosteal pocket

will provide secure placement without any additional fixation such as suturing.

During electrode insertion it is important for the electrode array

to approach the anterior portion of the basal turn at an insertion vector

so that it slides along the lateral wall of the scala tympani.

The insertion speed should be as slow as possible

to minimize intra-cochlear pressure.

If using a FLEX electrode array orient the single contacts

along the apical portion of the array towards the modiolus

so that the marker dot at the base of the array

will point towards the modiolus after insertion.

Step 5: Electrode lead placement.

After electrode insertion is completed

the extra cochlear electrode lead can be looped against the wall of the mastoid cavity

and hidden underneath the mastoid overhang.

Place the electrode lead into the drilled electrode channel.

A narrow electrode channel with overhang

or halfbridge technique are also optional.

If the electrode lead cannot be fully recessed in the electrode channel,

it is recommended to cover the electrode lead with bone pate.

It is essential to have the electrode lead fully recessed and secured in the channel

because the channel helps prevent any impact directly against the electrode lead

Check electrode placement

and avoid any contact between the electrode lead and the muscular skin

to prevent micro movement of the electrode lead for the wound closure.