Cranial Sutures as a Cause of Osseointegration Failure in Bone-Anchored Implants: Case Reports

Abstract This report discusses 2 clinical cases where the failure of osseointegration in bone-anchored implants may be associated with their placement directly in cranial sutures. The increasing shift toward minimally invasive surgical techniques for implant placement, such as the minimally invasive Ponto surgery (MIPS) and the punch technique, raises concerns about the risk of inadvertently positioning implants on cranial sutures, which can lead to the failure of osseointegration. In the first case, the Ponto (Oticon) implant and abutment were placed using MIPS. Two months post-operation, minimal movement was observed until the implant was significantly displaced, necessitating its removal. A subsequent computed tomography (CT) scan revealed that the implant had been placed in the asterion. The second case involved a Bone Anchored Hearing Aid (BAHA-Cochlear) implant and abutment inserted via a punch and drill technique. Early mobilization of the abutment was observed, progressively worsening until the implant was removed 2 months post-operation. A CT scan showed that the implant was located at the parietooccipital suture. These cases highlight a potential complication of minimally invasive implant surgery, suggesting that blind placement could elevate the risk of implant failure due to interference with cranial sutures. This underscores the importance of enhancing surgical precision and pre-operative planning with imaging. Cite this article as: Risoud M, Beck C, Lemesre P, Vincent C, Toulemonde P. Cranial sutures as a cause of osseointegration failure in bone-anchored implants: case reports. B-ENT 2024;20(3):210-212.