3D titanium implant for orbital reconstruction after maxillectomy.

The surgical treatment of maxillary tumours often consists of an open subtotal or total maxillectomy with a subsequent significant defect. Reconstruction is, therefore, a major challenge for head and neck surgeons. Along with 3D printing development, titanium pre-bent implants have been created for orbital wall and floor reconstruction. The aim of this study was to evaluate the post-operative tolerance of these implants in patients who had undergone this procedure in our department. Implant tolerance was the primary endpoint, evaluated by whether or not surgery was required for infection or extrusion 6 months after the procedure. The secondary endpoints were satisfactory functional and aesthetic characteristics of the reconstruction as well as the quality of life. Eleven patients underwent a maxillectomy with orbital floor resection for tumours and reconstruction using the titanium PorousiTi® (Materialise®, Leuven, Belgium) implant beginning in 2013 in Lariboisière Hospital, Paris. The mean follow-up time was 17 months (range, 6-34). During the follow-up period, two patients (n = 2/11; 18.2%) were operated again for implant extrusion and exposure through the skin 1 month later or during their radiotherapy course. During the follow-up period, no post-operative infection occurred in any of the patients. In our experience, the implant was well-tolerated with few post-operative complications and satisfactory aesthetic and functional results.

Use of auditory steady-state responses in children and comparison with other electrophysiological and behavioral tests.

OBJECTIVE: In patients who cannot or will not cooperate in behavioral hearing assessment, electrophysiological examinations are used, but are time-consuming because the subject has to remain immobile. The aim of this study was to assess whether auditory steady-state responses (ASSR) are sufficiently reliable, compared to auditory brainstem responses (ABR) and free-field audiometry, for assessment to begin with ASSR instead of ABR. MATERIAL AND METHODS: A retrospective study was performed between January 2012 and April 2013, including children less than 6 years of age who could not be tested via headphones. ASSR and ABR were measured during natural sleep or under phenobarbital-alimemazine sedation. Subjective pure-tone audiometry was performed, using the visual reinforcement audiometry method, in 69 children who were able and willing to cooperate. RESULTS: A total of 175 children were included. ASSR and ABR thresholds showed good positive correlation (338 ears; Pearson's correlation coefficient, 0.87). Behavioral thresholds correlated significantly with ASSR thresholds (Student t-test for matched series; P<0.05). ASSR thresholds were usually better than behavioral thresholds, with a difference of 8-15dB HL. CONCLUSION: ASSR is reliable in children under 6 years of age, and should be performed before ABR when hearing threshold rather than latency is to be determined.