Background: Passive transcutaneous osseointegrated hearing implant systems have become increasingly popular\nmore recently. The area over the implant is vulnerable due to vibration and pressure from the externally worn sound\nprocessor. Good perfusion and neural integrity has the potential to reduce complications. The authors� objective was to\ndetermine the ideal surgical exposure to maintain perfusion and neural integrity and decrease surgical time as a result\nof reduced bleeding.\nMethods: The vascular anatomy of the temporal-parietal soft tissue was examined in a total of 50 subjects. Imaging\ndiagnostics included magnetic resonance angiography in 12 and Doppler ultrasound in 25 healthy subjects to reveal\nthe arterial network. Cadaver dissection of 13 subjects formed the control group. The prevalence of the arteries were\nstatistically analyzed with sector analysis in the surgically relevant area.\nResults: The main arterial branches of this region could be well identified with each method. Statistical analysis showed\nthat the arterial pattern was similar in all subjects. The prevalence of major arteries is low in the upper posterior area\nthough large in proximity to the auricle region.\nConclusions: Diverse methods indicate the advantages of a posterior superior incision because the major arteries and\nnerves are at less risk of damage and best preserved. Although injury to these structures is rare, when it occurs, the\ndistal flow is compromised and the peri-implant area is left intact. Hand-held Doppler is efficient and cost-effective in\nfinding the best position for incision, if necessary, in subjects with a history of surgical stress to the retroauricular skin.
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