Different surgical solutions have been proposed for reconstruction of the auricle following loss of the pinna through traumatic injury or neoplastic disease or in patients with congenital defects. Surgical treatment may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has yielded good results but requires more than one surgical step, and adverse events can occur both at the donor and at the acceptor site; cases of prosthesis rejection have also been described following application of the polymeric prosthesis. The use of a titanium, dowel-retained silicone prosthetic pinna, fixed to the temporal bone, has recently been proposed. This useful surgical approach is indicated particularly after resection of the pinna caused by neoplastic disease or in traumatic auricular injury. Osseointegrated titanium implants used in 27 patients in this study provided them with a safe, reliable, adhesive-free method of anchoring the auricular prostheses. The prostheses allowed recovery of normal physical appearance and all the patients reported that they were completely satisfied with the outcome of the surgical reconstruction. No surgical complications, implant failures, or prosthetic failures were encountered over six months to three years.

Acid attacks committed as crimes of passion are unfortunately becoming far from infrequent occurrence. The injuries sustained in such attacks mainly involve the face and trunk, with the acid causing cutaneous and subcutaneous tissue burns that can result in permanent scarring, loss of the nose or external ear, and severe visual impairment. Different surgical solutions have been proposed for reconstruction of the auricle following loss of the ear through traumatic injury or cancer or in patients with congenital defects: surgical reconstruction may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has given good results but requires more than one surgical step and may be associated with adverse events involving both the donor site and the recipient site, while rejections of polymeric prostheses have been reported following their insertion into expanded postauricular flaps. The use of a titanium dowel-retained silicone prosthesis, in which the dowel is anchored to the temporal bone, is a surgical possibility, indicated particularly in cases of pinna resection due to tumour or auricular scarring following traumatic injury.