Cochlear Baha Attract Surgery. Aurélie Dewael Education Manager Cochlear Academy EMEA

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1 Cochlear Baha Attract Surgery Aurélie Dewael Education Manager Cochlear Academy EMEA

2 Straightforward surgical procedure Mean surgery time: 40 min. 85% of the surgeries with the recommended C-shaped incision. 29% of the surgeries with bone polishing. 25% of the surgeries with soft tissue thinning. Periosteum preserved in 92% of the surgeries. 89% with the 4 mm BI300 Implant.

3 Osscora (Drill) Built in irrigation Easy to programme foot pedal Sterilisable Motor and Hand Piece

4 Instrument Cassette Attract Instruments Indicator for Baha Attract New Bone Bed Indicator Implant magnet template. Bone bed indicator Instruments for Attract Soft tissue gauge 6mm

5 Sterile single patient use components Coolant Hose Conical guide drill 3+4 mm Widening drill 4 mm BIM400 Implant Magnet BI300 Implant 4 mm

6 Placement of the implant Sound processor part of indicator in line with the top of the ear 50-70mm from ear canal opening

7 Placement of the implant for a Baha 5 Super Power Identify and mark the implant site with the white Indicator for Baha 5 SuperPower, Baha Attract System, at least 68 mm from the ear canal.

8 Preparing the site- pre infiltration Incision position Easier to raise a thin flap in the avascular plane Soft tissue is often thinner in the anterior area compared to the posterior area. Less bleeding in the superior/anterior area than the inferior/posterior area Incision at least 15mm from Magnet edge Checking Tissue Depth At several points of the magnet area Implant site- Tattoo down to periosteum

9 Make the incision- 15mm from Magnet edge Infiltrate the site with local anaesthetic and adrenaline Incision down to but NOT through the periosteum. Retract soft tissue posteriorly/superiorly via blunt dissection. The temporalis is retracted superiorly down to the periosteum.

10 If you have lost the Implant mark remark

11 Magnet Template Place the implant magnet template on the periosteum to ensure good positioning of the implant magnet in relation to the incision and the bone. Open up the incision using 1 or 2 self retaining retractors. Mark the selected position of the implant on the periosteum with a pen or with the sharp tip on the magnet template.

12 Implant Position Make a cruciate incision (6 mm square) in the periosteum to expose enough bone for the implant flange. Raise the edges with the raspatorium. PERIOSTEUM MUST REMAIN INTACT EXCEPT AT THE IMPLANT SITE

13 Drill with the Conical guide drill Drill at an angle perpendicular to the bone surface, using the drill indicator and abundant irrigation during all drilling procedures. Begin drilling with the guide drill with 3 mm spacer (2000 rpm). Move the burr up and down to ensure visual inspection and that coolant reaches the tip of the drill. Check the bottom of the hole. If there is adequate bone thickness, remove the white spacer and continue drilling to a depth of 4 mm. CHECK YOU ARE FULLY DOWN TO 4MM

14 Drill with the widening drill Widen the hole with the relevant widening drill (2000 rpm). Move the widening drill up and down during drilling to ensure that coolant reaches the tip of the drill. The widening drill is designed to allow early recognition when countersinking is complete.

15 Set drill to low speed 15 rpm and torque according to the bone quality Ensure the Implant inserter goes into the Implant with an audible click DO NOT LEAVE IMPLANT PROUD OF BONE SmartPeg Sterile Type 30 Listen for the audible beep on the drill unit Before removing the hand piece Ensure the Implant is fully seated in the bone

16 Checking the Bone Bed Bone Bed Indicator Finger tighten only, turn clockwise Turning anti clockwise will loosen the indicator If required-polish the Bone After polishing place periosteum back, close to the Implant Too help avoid osseointegration of the magnet Smooth machined Periosteum under magnet will also help

17 > Magnet Placement When placing Magnet towards top of patients head Always hold magnet with fingers to counter torque Hand tighten with unigrip screwdriver Final tightening- 25 Ncm Multi Wrench and ISO adapter, unigrip machine screwdriver

18 Tissue thickness If the tissue is more than 6mm it will need thinning Remember with the tissue there will still be local anaesthetic so could give an unreal reading Trauma of the tissue caused by the surgery can also cause swelling Take both measurements into account

19 Close and suture Place the flap over the implant magnet and suture. Ensure suturing of the deep layer to the periosteum or suture the skin to the periosteum and back to the skin. Do not suture in the implant magnet area where pressure will later be applied. Apply a pressure dressing over the wound for hours. Fitting 4 weeks Not about osseointegration About healing of the tissue

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21 Summary To perform a Baha Attract surgery you have to ensure the extra Baha Attract surgical instruments are available for your surgeon. An Attract surgery is simple but needs attention to detail The implant must be placed correctly and not proud of the bone The arrow of the magnet must be pointing to the top of the head

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