Journal of Stomatology, Oral and Maxillofacial Surgery
Case ReportBilateral auricular reconstruction with osseointegrated implant-retained prostheses. Optimization of aesthetic outcomes using virtual planning
Introduction
Microtia is a congenital deformity that affects the external ear with different degrees of severity. From an ear altered in its size, morphology or implantation to the complete absence of the pinna and the external auditory canal (anotia). The incidence is 3 per 10,000 live births and only in 10% of cases is bilateral.
Auricle reconstruction represents one of the most important challenges for reconstructive surgery, especially in bilateral cases [1]. Reconstruction with osseointegrated implants is a procedure accepted by the scientific comm unity that provides an excellent treatment option, with very good aesthetic results and satisfaction for the patient, as well as little or no morbidity [2]
The objective of this reconstruction in patients with uni- or bilateral anotia is to alleviate the psychosocial morbidity, which both the family environment and the patient himself suffer from since birth. The final aesthetic outcomes are conditioned, among other factors, by the symmetrical disposition of the auricular epithesis, which in turn are influenced by the position of the implants. The development of digital technologies and the virtual planning of the whole process optimizes the aesthetic outcomes.
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Materials and methods
8-year-old patient with bilateral anotia and partial development of the external auditory canal, presents auditory deficit, alteration of the facial appearance and severe psychological affectation (Fig. 1). At 8 years of age we made epithetics for both earlobes retained in osseointegrated implants, the whole process being virtually planned. Diagnosis consisted of clinical images and a 3D CT-scan.
The proportions and the relative position of the ear with respect to the face, the jaw and the
Results
The osseointegration of all the implants was successful.
The epithelialization of the connections between the bar and one of the implants acquired a hyperplastic and inflammatory aspect, which required a small surgery to clean and remove the surrounding tissue and the subcutaneous tissue again (Fig. 6). The prosthetic tests were poorly tolerated by the patient due to psychological fatigue and impatience about the delay of the epithesis.
After two years of follow-up, decubitus areas have not been
Discussion
Microtia is a congenital malformation of the external ear that can seriously affect the psychological and physiological well-being of affected children.
Auricle reconstruction represents one of the most important challenges for reconstructive surgery, especially in bilateral cases. The characteristics of the skin of the area, the scarring and the morbidity of the donor site make the procedure difficult, which leads to sometimes unsatisfactory results [1].
Currently, autologous costal graft is the
Conclusion
Auricular reconstruction with autologous tissues represents one of the most important challenges for reconstructive surgery, especially in cases of bilateral microtia. The reconstruction of the ear by epithesis retained using osseointegrated implants is an excellent treatment option. Virtual planning, stereolithographic models and surgical guides optimize aesthetic results.
Disclosure of interest
The authors declare that they have no competing interest.
Acknowledgments
Our thanks and recognition to Dr. Enrique Damborenea, anaplastologist, for the excellent results obtained in the preparation of the epithesis.
References (13)
Autologous rib microtia construction: nagata technique
Facial Plast Surg Clin North Am
(2018)- et al.
In vitro regeneration of patient-specific ear-shaped cartilage and its first clinical application for auricular reconstruction
EBioMedicine
(2018) Pediatric microtia reconstruction with autologous rib: personal experience and technique with 1000 pediatric patients with microtia
Facial Plast Surg Clin North Am
(2018)- et al.
Survival and complications of implants to support craniofacial prosthesis: a systematic review
J Craniomaxillofac Surg
(2016) A new method of total reconstruction of the auricle for microtia
Plast Reconstr Surg
(1993)- et al.
Osseointegrated alloplastic versus autogenous ear reconstruction: criteria for treatment selection
Plast Reconstr Surg
(1994)