Page 134 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

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Chapter 7
Prosthetic ear reconstruction was preferred by all observer panels over autologous reconstruction with regard to the overall anatomical shape. Results showed significant differences in appreciation of type of reconstruction in favor of prosthetic rehabilitation of both nasal- and auricular anatomical subunits. This is in accordance with the finding of Zuo et al. (2016), which describe superior aesthetic results in comparison to autogenous methods57. This finding indicates that the reconstructive surgeon should focus on the reconstruction as a unity, rather than specific anatomical substructures.
Comparison of our results with literature is difficult due to the wide variety of questionnaires and methodological approaches. Most of the pediatric patients with autologous reconstructed ears suffered from microtia. Literature describes autogenous reconstruction as the accepted standard approach in these cases58,59. Only in unfavorable cases with failed autogenous reconstruction, severe soft-tissue and/or skeletal hypoplasia with a low or unfavorable hairline, or in post-traumatic or post- ablative defects, osseointegrated auricular reconstruction is considered58. A drawback of prosthetic reconstruction is the need for ongoing maintenance and exclusion of possible subsequent autologous reconstruction when osseointegrated implants are placed. Therefore, the age of the patient should be taken into account. Ears continue to grow throughout life, although only moderate increase occurs after the first 8–10 years59. Completion of nasal growth takes place at the approximate age of 16 years old in men and 14 years old in women60. Restricted thickness of the parietal and temporal bone is no limiting factor for implant installation as short implants can be applied61.
In conclusion, although observer variability is present in the current study, prosthetic reconstructions of auricular and nasal defects tend to be advantageous in subjective aesthetic outcome. It is the task of the surgeon and multidisciplinary team to enable patients to make a well-informed decision. Surgical reconstructive options may be selected based upon surgeon-preference, as well as the available expertise of surgical and prosthetic colleagues in clinically equivalent situations.