Facial plast Surg 2009; 25(3): 190-203
DOI: 10.1055/s-0029-1239446
© Thieme Medical Publishers

Ear Epistheses as an Alternative to Autogenous Reconstruction

Philipp A. Federspil1 , 2
  • 1Department of Oto-Rhino-Laryngology, University Hospital Heidelberg, Heidelberg, Germany
  • 2Vice president of the International Association for Surgical Prosthetics and Episthetics (IASPE, Linz, Austria)
Further Information

Publication History

Publication Date:
06 October 2009 (online)


An ear episthesis is an artificial substitute for the auricle. The term ear prosthesis is used synonymously. The breakthrough came with the introduction of the modern silicones and their colorings. Although there are still indications for noninvasive methods of retention such as medical adhesives, the best and most reliable method of fixation is by bone anchorage. Long-lasting osseointegration with reaction-free skin penetration can be achieved with titanium implants. The first system used extraorally was the Brånemark flange fixture. Later, different solitary titanium implants were introduced, such as the ITI system. A different strategy used the titanium grids (Epitec) or plates (Epiplating) derived from osteosynthesis systems. These systems are fixed subperiosteally with several bone screws and are therefore also labeled as grouped implants. With these modern developments, secure retention can be achieved also in unfavorable anatomic situations. The grouped systems are resistant to torque with abutment insertion. The latest development is the subcutaneously implanted double magnet without skin penetration. The advantages of implant retained ear epistheses include optimal camouflage, predictable cosmetic results, fast rehabilitation, no donor site morbidity, and early detection of tumor recurrence. Depending on the clinical setting, prosthetic rehabilitation may be more than just an alternative to plastic reconstructive surgery.