Prosthetic Reconstruction of the Auricle: Indications, Techniques, and Results

Abstract

Extensive defects of the ear require satisfactory cosmetic reconstruction to enable the patient to achieve full social integration. Although surgical procedures are the gold standard for reconstruction of the ear, in some cases they cannot be performed because of extended scars, threatening tumor, or congenital tissue abnormalities. Prosthetic reconstruction of the auricle is an established and reliable alternative technique to autologous surgical reconstructions. Since studies performed by Brånemark, osseointegrated implants have been widely used to provide a reliable and stable anchorage for a prosthesis (prosthesis anchored to bone). To allow good osseointegration of the titanium screw implants, two stages are necessary. After careful preparation for the surgical procedure (local and general examination, computed tomography scan, skin preparation), screws are implanted into bone, which are then covered by a skin flap. During the second stage, the skin is incised, and penetrating fixtures are attached to the screw implants, which allow fixation of the prosthesis. This procedure is reliable and reproducible, with good to excellent results and stability over time.

Clinical Outcomes of Osseointegrated Prosthetic Auricular Reconstruction in Patients With a Compromised Ipsilateral Temporoparietal Fascial Flap

“…27 In contrast, there were no implant failures (0/65) in the 27 nonirradiated patients. Prior head and neck irradiation is not a contraindication for maxillofacial implant osseointegration in patients with cancer; 24,28 however, there is controversy regarding how best to preoperatively optimize these patients. 29 The highest survival rates for implants in irradiated extraoral applications are in the temporal bone, where the densely corticated and well-vascularized bone ensures a robust bone-implant interface to support functional loading.…”

“…A delay period of 6 to 18 months after irradiation may permit soft tissue and bony healing stabilization before osseointegration surgery. 28 The use of a radiation shield to protect anticipated prosthetic sites has also been described. 18,33 A systematic review of temporal bone osseointegrated implants by Granström 30 in 2003 found that implant survival is high in irradiated patients up to 5 years postoperatively, after which time failures are common.…”

Bone-Anchored Titanium Implants in Patients with Auricular Defects: Three Years and 27 Patients’ Experience

“…Local skin infection around the fixture could occur, as could the formation of granulation tissue and keloids. These are complications that can be avoided or resolved using appropriate medication and topical treatments without loss of the fixture [21]. …”

Prosthetics in Facial Reconstruction

“…Throughout history, materials such as silver, leather, porcelain, paper-mache, gelatin, latex, and acrylic were employed in prosthetic reconstruction. 24,25 Development of an ideal facial prosthetic relies on factors such as durability, flexibility, weight, color matching, longevity, biocompatibility, texture, hygiene, and thermal conductivity. 26 Modern materials used for head and neck prostheses are divided into methacrylates, polyurethane elastomers, and silicone elastomers.…”