Implant Retained Auricular Prostheses

Abstract

Reconstruction of a facial defect is a complex modality either surgically or prosthetically, depending on the site, size, etiology, severity, age, and the patient's expectation.The loss of an auricle, in the presence of an auditory canal, affects hearing, because the auricle gathers sound and directs it into the canal.The auricle acts as a resonator to slightly amplify lower frequency sounds and helps to localize sounds, especially in conjunction with the other ear.(Wright et al., 2008Karakoca et al., 2010, Toljanic et al., 2005) Recently developed surgical reconstruction techniques, including microsurgical tissue transfer and autogenous or alloplastic grafts, have been used for the reconstruction of auricular defects.More than 40 different cartilaginous, osseous, and alloplastic frame materials for auricular reconstruction have been described since 1891.Reconstructive techniques for auricular defects include second intention healing simple linear closures, skin grafts if the perichondrium and soft tissue are intact, local rotation flaps, two-lobed advancement flaps from the post-auricular sulcus, and post-auricular interpolation flaps for larger defects of the ear ear rim (Vergilis-Kalner et al, 2010, Goldberg et al, 1996).Away from the helical rim, donor skin from the posterior surface of the ear is easily obtainable and the defect can be closed with a vertically oriented side-to-side closure.Other reconstruction options for an auricular defect, adjacent to and on the helical rim, include the helical rim advancement flap, helical advancement flap, wedge excision, or a post-auricular interpolation flap from the scalp (Justiniano & Eisen, 2009, Vergilis-Kalner et al, 2010).Most of the local options involve extensive undermining, often into the hair-bearing portions of the scalp (Cordeiro et al, 2007, Vergilis-Kalner et al, 2010) [3].Closing the ear defects still represents a reconstructive challenge because of the lack of available freely mobile skin anteriorly, superiorly, and inferiorly to the defect.(Vergilis-Kalner et al, 2010) According to Vergilis-Kalner et al., the choice of the bilobed flap circumvents this challenge by using skin from the posterior surface of the ear and, as necessary, from the post-auricular groove.In addition, bilobe flap is a one-stage repair in which donor tissue is transferred from the area of excess, such as from the post-auricular sulcus, lower pole of the posterior ear, or superior neck adjacent to the posterior ear, rotated anteriorly, folded forward, and fitted into the defect over the exposed cartilage.(Vergilis-Kalner et al, 2010) Vergilis Kalner et al suggested that, the bilobed flap is a useful technique for transferring local tissue while simultaneously minimizing donor-site deformity and described two cases in which a bilobed flap was used to rotate skin from the post-auricular surface to reconstruct full www.intechopen.comCurrent Concepts in Plastic Surgery 50 thickness skin defects involving the helical rim and posterior ear, with excellent cosmetic resultsCombined with coverage of the framework by a temporoparietal fascia flap and autologous skin grafts, this surgical approach of auricular reconstruction is reported not only to yield reliable results but also to be associated with a low complication rate.However, an auricular prosthesis is the efficient alternative, when aesthetic and functional demands cannot be surgically fulfilled.Complete rehabilitation of patients with auricular defect is achieved using a multidisciplinary team approach, involving surgical and prosthetic personnel.Treatment requires cooperation between those treating the disease and those responsible for the emotional wellbeing of the patient.Retention and stability of prostheses improve the patient's confidence and sense of security.