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Semin Plast Surg 2011; 25(4): 265-272
DOI: 10.1055/s-0031-1288918
© Thieme Medical Publishers

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

Jean-Philippe Giot1 , Daniel Labbé1 , Eric Soubeyrand1 , Régine Pacini2 , Marie-Reine Guillou-Jamard1 , Jean-François Compère1 , Hervé Bénateau1
  • 1Service de Stomatologie, Implantologie, Chirurgie Maxillo-Faciale, Plastique et Reconstructrice, CHU de Caen, Faculté de Médecine, Université de Caen, France
  • 2Société Epithèses de Normandie, Bois-Guillaume, France
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Publication Date:
20 October 2011 (online)

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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.

KEYWORDS

Prosthesis - ear - osseointegration - plastic surgery

REFERENCES

  • 1 Benoist M. Réhabilitation et prothèse maxillo-faciales. Paris: Prélat; 1978: 454
    Search in Google Scholar
  • 2 Firmin F. State-of-the-art autogenous ear reconstruction in cases of microtia.  Adv Otorhinolaryngol. 2010;  68 25-52
    Search in Google Scholar
  • 3 Firmin F. [Secondary reconstruction of the external ear destroyed by burns. Indications and techniques. Apropos of 30 clinical cases].  Ann Chir Plast Esthet. 1995;  40 (3) 252-263
    Search in Google Scholar
  • 4 Firmin F. [Value of tissue expansion in total reconstruction of the external ear].  Ann Chir Plast Esthet. 1996;  41 (5) 495-502
    Search in Google Scholar
  • 5 Firmin F. Ear reconstruction in cases of typical microtia. Personal experience based on 352 microtic ear corrections.  Scand J Plast Reconstr Surg Hand Surg. 1998;  32 (1) 35-47
    Search in Google Scholar
  • 6 Firmin F, Sanger C, O'Toole G. Ear reconstruction following severe complications of otoplasty.  J Plast Reconstr Aesthet Surg. 2008;  61 (Suppl 1) S13-S20
    Search in Google Scholar
  • 7 Jost G, Firmin M F. [Restoration of the relief of the helix root in reconstructions of the external ear].  Ann Otolaryngol Chir Cervicofac. 1969;  86 (10) 675-678
    Search in Google Scholar
  • 8 Labbé D, Bénateau H, Compère J F, Sabin P. [Extra-oral implants: indications and contraindications].  Rev Stomatol Chir Maxillofac. 2001;  102 (5) 239-242
    Search in Google Scholar
  • 9 Sabin P, Bonin B. [Indications for extra-oral implants: strategic methods apropos of a clinical case].  Rev Stomatol Chir Maxillofac. 2001;  102 (5) 249-252
    Search in Google Scholar
  • 10 Wilkes G H, Wolfaardt J F. Osseointegrated alloplastic versus autogenous ear reconstruction: criteria for treatment selection.  Plast Reconstr Surg. 1994;  93 (5) 967-979
    Search in Google Scholar
  • 11 Thorne C H, Brecht L E, Bradley J P, Levine J P, Hammerschlag P, Longaker M T. Auricular reconstruction: indications for autogenous and prosthetic techniques.  Plast Reconstr Surg. 2001;  107 (5) 1241-1252
    Search in Google Scholar
  • 12 Sabin P, Cadre B, Ferrand J Y, Pacini R, Labbé D. [Bone-anchored implants: comparison of the techniques and values of endo- and juxta-bone implants].  Rev Laryngol Otol Rhinol (Bord). 1997;  118 (2) 103-107
    Search in Google Scholar
  • 13 Farmand M. [A new implant system for the fixation of facial prostheses].  Dtsch Z Mund Kiefer Gesichtschir. 1991;  15 (6) 421-427
    Search in Google Scholar
  • 14 Federspil P. Delb W: Treatment of congenital malformations of the external and middle ear. In Ars B (ed): Congenital External and Middle Ear Malformations. Amsterdam, New York; Kugler, 1992, pp 47-71
  • 15 Halsnad S M, Srinivasan D, Jeynes P, Sharp I. Re: P. Gentile, F. Nicoli, R. Caruso, G. Gravante, V. Cervelli. Alternative strategy to reconstruct the nose after excision: extra-oral implant anchored to bone [Br. J. Oral Maxillofac. Surg. 47 (2009) 50-51].  Br J Oral Maxillofac Surg. 2009;  47 (6) 491-492
    Search in Google Scholar
  • 16 Badie-Modiri B, Kaplanski P. [Extra-oral implants: principal areas of implantation].  Rev Stomatol Chir Maxillofac. 2001;  102 (5) 229-233
    Search in Google Scholar
  • 17 Tjellström A. Osseointegrated implants for replacement of absent or defective ears.  Clin Plast Surg. 1990;  17 (2) 355-366
    Search in Google Scholar
  • 18 Jensen O T, Brownd C, Blacker J. Nasofacial prostheses supported by osseointegrated implants.  Int J Oral Maxillofac Implants. 1992;  7 (2) 203-211
    Search in Google Scholar
  • 19 Jacobsson M G, Jönsson A K, Albrektsson T O, Turesson I E. Short- and long-term effects of irradiation on bone regeneration.  Plast Reconstr Surg. 1985;  76 (6) 841-850
    Search in Google Scholar
  • 20 Jacobsson M, Tjellström A, Thomsen P, Albrektsson T, Turesson I. Integration of titanium implants in irradiated bone. Histologic and clinical study.  Ann Otol Rhinol Laryngol. 1988;  97 (4 Pt 1) 337-340
    Search in Google Scholar
  • 21 Kosmidou L, Toljanic J A, Moran W J, Panje W R. The use of percutaneous implants for the prosthetic rehabilitation of orbital defects in irradiated cancer patients: a report of clinical outcomes and complications.  Int J Oral Maxillofac Implants. 1998;  13 (1) 121-126
    Search in Google Scholar
  • 22 Jacobsson M, Tjellstrom A, Fine L, Andersson H. A retrospective study of osseointegrated skin-penetrating titanium fixtures used for retaining facial prostheses.  Int J Oral Maxillofac Implants. 1992;  7 (4) 523-528
    Search in Google Scholar
  • 23 Abu-Serriah M M, Bagg J, McGowan D A, Moos K F, MacKenzie D. The microflora associated with extra-oral endosseous craniofacial implants: a cross-sectional study.  Int J Oral Maxillofac Surg. 2000;  29 (5) 344-350
    Search in Google Scholar
  • 24 Granström G, Jacobsson M, Tjellström A. Titanium implants in irradiated tissue: benefits from hyperbaric oxygen.  Int J Oral Maxillofac Implants. 1992;  7 (1) 15-25
    Search in Google Scholar
  • 25 Granström G, Tjellström A, Brånemark P I. Osseointegrated implants in irradiated bone: a case-controlled study using adjunctive hyperbaric oxygen therapy.  J Oral Maxillofac Surg. 1999;  57 (5) 493-499
    Search in Google Scholar
  • 26 Johnsson A A, Sawaii T, Jacobsson M, Granström G, Turesson I. A histomorphometric study of bone reactions to titanium implants in irradiated bone and the effect of hyperbaric oxygen treatment.  Int J Oral Maxillofac Implants. 1999;  14 (5) 699-706
    Search in Google Scholar
  • 27 Andersson G, Andreasson L, Bjelkengren G. Oral implant rehabilitation in irradiated patients without adjunctive hyperbaric oxygen.  Int J Oral Maxillofac Implants. 1998;  13 (5) 647-654
    Search in Google Scholar
  • 28 Bodard A G, Gourmet R, Lucas R, Bonnet E, Breton P. [Dental implants in irradiated areas: a series of 33 patients].  Rev Stomatol Chir Maxillofac. 2006;  107 (3) 137-142 discussion 143-144
    Search in Google Scholar
  • 29 Bénateau H, Crasson F, Labbé D, Riscala S, Alix T. [Extra-oral implants and irradiation: current trends].  Rev Stomatol Chir Maxillofac. 2001;  102 (5) 266-269
    Search in Google Scholar
  • 30 Brix M, Badie-Modiri B, Delcampe P. [Extra-oral implants: surgical procedures].  Rev Stomatol Chir Maxillofac. 2001;  102 (5) 243-247
    Search in Google Scholar
  • 31 Gentile P, Nicoli F, Caruso R, Gravante G, Cervelli V. Alternative strategy to reconstruct the nose after excision: extra-oral implant anchored to bone.  Br J Oral Maxillofac Surg. 2009;  47 (1) 50-51
    Search in Google Scholar
  • 32 Sabin P, Labbé D, Ferrand J Y, Daburon P, Compere J F. [Maxillofacial prosthesis fixed on endosseous implants. Apropos of 15 cases].  Ann Chir Plast Esthet. 1995;  40 (4) 363-370
    Search in Google Scholar
  • 33 Gitto C A, Plata W G, Schaaf N G. Evaluation of the peri-implant epithelial tissue of percutaneous implant abutments supporting maxillofacial prostheses.  Int J Oral Maxillofac Implants. 1994;  9 (2) 197-206
    Search in Google Scholar
  • 34 Holgers K M, Bjursten L M, Thomsen P, Ericson L E, Tjellström A. Experience with percutaneous titanium implants in the head and neck: a clinical and histological study.  J Invest Surg. 1989;  2 (1) 7-16
    Search in Google Scholar
  • 35 Holgers K M, Ljungh A. Cell surface characteristics of microbiological isolates from human percutaneous titanium implants in the head and neck.  Biomaterials. 1999;  20 (14) 1319-1326
    Search in Google Scholar
  • 36 Holgers K M, Roupe G, Tjellström A, Bjursten L M. Clinical, immunological and bacteriological evaluation of adverse reactions to skin-penetrating titanium implants in the head and neck region.  Contact Dermat. 1992;  27 (1) 1-7
    Search in Google Scholar
  • 37 Toljanic J A, Morello J A, Moran W J, Panje W R, May E F. Microflora associated with percutaneous craniofacial implants used for the retention of facial prostheses: a pilot study.  Int J Oral Maxillofac Implants. 1995;  10 (5) 578-582
    Search in Google Scholar

Daniel LabbéM.D. 

4 Place Fontette

14000 Caen, France

Email: dr.labbe@wanadoo.fr