Prosthetic Ear Research Articles

A novel design for prosthetic ear guiding device: A technical note

This article describes a newly designed Prosthetic Auricular Guide (PAG) that allows for accurate planning and positioning of both the auricular implants and the prosthetic auricle. The design aims to provide a cost-effective guiding device for more esthetic ear prostheses which is the patient's main concern. Along with determining the best clinically accepted position of the ear, the device can be used while taking CBCT which allows for the integration of the clinically approved position with the remaining bone for accurate planning of implant positions. Furthermore, the device can be fixed during surgery for accurate transmission of the planned position. The device is also adjustable making it suitable for all patterns of auricular defects, different ages, and even for patients with asymmetric faces.

A custom auricular implant healing abutment: A dental technique

Skin overgrowth is a complication that hinders bone-anchored prosthetic ear rehabilitation. In order to accurately transfer the healing skin for prosthetic reconstruction, this article introduces a custom-made autopolymerizing acrylic resin auricular cap (button) through indirect pick up of the metal housing. The caps are secured during the healing stage to shape the skin, preventing surgical edema, swelling, and skin overgrowth in patients suffering from keloid reactions from covering the implant abutments. Since skin height and form are changeable, the caps can be relined directly or indirectly if greater skin compression is required. Moreover, these custom-made caps can be utilized during prosthetic silicone ear fabrication to retain the metal housing.

An innovative digital workfl ow for the fabrication of a prosthetic ear: A case report

The aim of maxillofacial rehabilitation is to provide suitable prostheses for patients with oro-facial defects, and enable them to resume their roles in society. Recent advances in bionics and prosthetics have combined different techniques to help in the production of aesthetic and functional prostheses. Technology can now supplement the freehand sculpting skills of the clinician by capturing accurate images of the soft tissues from both the defect and non-defect areas, and using these to digitally recreate the desired templates. This case report describes the digital steps used to capture necessary data for the design and fabrication of an auricular template, and fi nal ear prosthesis. Results from this case study suggested that the digital method is: 1) more accurate; 2) less time-consuming than traditional methods; and 3) less invasive, and thus more accepted by patients.

An automated parametric ear model to improve frugal 3D scanning methods for the advanced manufacturing of high-quality prosthetic ears

Ear prostheses are commonly used for restoring aesthetics to those suffering missing or malformed external ears. Traditional fabrication of these prostheses is labour intensive and requires expert skill from a prosthetist. Advanced manufacturing including 3D scanning, modelling and 3D printing has the potential to improve this process, although more work is required before it is ready for routine clinical use. In this paper, we introduce a parametric modelling technique capable of producing high quality 3D models of the human ear from low-fidelity, frugal, patient scans; significantly reducing time, complexity and cost. Our ear model can be tuned to fit the frugal low-fidelity 3D scan through; (a) manual tuning, or (b) our automated particle filter approach. This potentially enables low-cost smartphone photogrammetry-based 3D scanning for high quality personalised 3D printed ear prosthesis. In comparison to standard photogrammetry, our parametric model improves completeness, from (81 ± 5)% to (87 ± 4)%, with only a modest reduction in accuracy, with root mean square error (RMSE) increasing from (1.0 ± 0.2) mm to (1.5 ± 0.2) mm (relative to metrology rated reference 3D scans, n = 14). Despite this reduction in the RMS accuracy, our parametric model improves the overall quality, realism, and smoothness. Our automated particle filter method differs only modestly compared to manual adjustments. Overall, our parametric ear model can significantly improve quality, smoothness and completeness of 3D models produced from 30-photograph photogrammetry. This enables frugal high-quality 3D ear models to be produced for use in the advanced manufacturing of ear prostheses.

Klippel-Feil Syndrome: Oral and maxillofacial rehabilitation: Rare case report

Klippel-Feil Syndrome is a complex condition due to aberrant fusion of two or more cervical vertebrae characterised by short neck, low hairline, facial asymmetry and limited neck movement. Mandibular hypoplasia, submucous cleft, congenitally missing teeth, facial asymmetries and mouth breathing are frequently observed in patients with Klippel-Feil Syndrome. Management is symptomatic and supportive which necessitates a multidisciplinary expertise. This case report describes the dental management and prosthetic ear rehabilitation executed on a 12-year-old female patient with Klippel-Feil Syndrome.

Fascial turnover flap - an effective method to resolve cartilage exposure after autologous microtia reconstruction

Introduction. Microtia presents a congenital ear deformity ranging from a minor and barely visible defect to a complete absence of the ear. Currently, there are three options for ear reconstruction: autologous costal cartilage, silicon prothesis, and prosthetic ear. Ear reconstruction with autologous costal cartilage is usually performed in two stages. During the first stage, the cartilaginous framework is fabricated and placed under the skin, in the anatomical position of the ear. In the second stage, the elevation of the frame is performed. During these procedures, complications such as vascular compromise of the skin envelope can occur. Cartilage exposure can lead to its resorption and distortion, leading to an unsatisfactory anatomical result, and this should be resolved as soon as possible. Cartilage exposure at the convex part of the frame is especially problematic. The goal of this paper is to show that fascial turnover flap is a safe method to deal with cartilage exposure as a complication. Outlines of cases. We present two patients with anotia and hemifacial microsomia. Both underwent autologous cartilage microtia repair. In both patients, the cartilage exposure at the convex part of the ear was revealed as a complication. Fascial turnover flap has been used to resolve this complication in both patients. Conclusion. Fascial turnover flap is a safe method to deal with cartilage exposure after microtia reconstruction with autologous cartilage.

Comparison and Applicability of Facial Prosthetic Ear Manufacturing Cases

As a result of synthesizing the advice of experts in facial prosthetics, customized prosthetics for special cosmetics, and medical device manufacturing and sales experts, work competencies that require '3D printing based on digital work methods' are required. It was confirmed that 'prosthesis production, 3D scanning and modeling, and 3D printing' skills are required for work competency. In order to develop a more realistic aesthetic part, more attention and research are being made on the production of implants, and prosthetic manufacturers are developing materials that can extend the durability, practicality, and aesthetic life of the material. Observe the case of the human prosthesis production ear and examine the case of ear production application technology using 3D printing of facial prosthesis with special makeup. Through interviews with three face prosthetic manufacturers, we would like to explore the usefulness of facial prosthetics and ways to utilize them through collaboration with special cosmetics in the art world.

CLINICAL AND RADIOGRAPHIC EVALUATION OF THE USE OF INTRAORAL IMPLANTS IN CONSTRUCTON OF SINGLE STAGE IMPLANT RETAINED AURICULAR PROSTHESES

INTRODUCTION: Although plastic surgery is capable of restoring missing tissues, it may not be the ideal choice of treatment because of the complex shape and structure. For restoration of complex organs such as ears, prosthetic restorations may be an alternative to surgical restorations due to their aesthetical success. Prosthetic rehabilitation to restore the facial disfigurements with custom made prosthetic devices may improve the level of function and patient’s self-esteem. Difficulties with facial prostheses may arise due to patient factors such as amount of soft tissue loss, location of the auricular defect, dynamic tissue beds, retentive quality of the area, and associated irritation of the tissue beds. Hence, the rehabilitation choice depends on meticulous restoration of physical dimensions, external contour, and surface landmarks to ensure satisfactory aesthetic outcomes for prosthodontists and their patients. OBJECTIVES: To use inrta-oral implant as an alternate of maxillofacial ones to retain auricular prostheses and evaluate autografted single stage implant placement surgery. MATERIALS AND METHODS: Ten patients complaining of congenitally missing ear either microtia or anotia or acquired missing ones were recruited from maxillofacial and prosthodontic departments’ outpatient clinics, Faculty of dentistry, Alexandria University. Patients were diagnosed clinically and radio-graphically using Cone Beam Computed tomography imaging (CBCT). The prosthetic ear was retained using three ball and socket attachments .They were evaluated upon radiographic and clinical level of osseointegration as well as patient acceptance and hygiene. RESULTS: None of the implants showed failure to osseointegration; providing a survival rate of 100% on both clinical and radiographic levels of evaluation. CONCLUSIONS: The use of 6 mm dental implants in the mastoid region succeeded to replace the maxillofacial implants. Single stage implant placement surgery minimized tissue traumatization and possessed higher patient satisfaction level.

Otologic considerations in a full face transplant recipient

Facial transplantation provides a functional and aesthetic solution to severe facial disfigurement previously unresolved by conventional reconstruction. Few facial allografts have been ear containing; hence, there is limited knowledge of the postoperative otologic considerations. We describe the case of a 44-year-old man who underwent transplantation of the total face, eyelids, ears, scalp, and skeletal subunits in 2015 after an extensive thermal injury. We detail the patient's transition from osseointegrated prosthetic ears to an ear-containing facial allograft, and describe the unique surgical approach and challenges encountered. Subsequent bilateral revision meatoplasties were performed, which provided relief from stenosis of the external auditory meatus. Laryngoscope, 129:2008-2011, 2019.

Osseointegrated Prosthetic Ear Reconstruction in Cases of Skin Malignancy: Technique, Outcomes, and Patient Satisfaction.

Ear reconstruction with osseointegrated prosthetic implants is a well-established method of reconstruction after resection of skin malignancies on the external ear. There is limited literature reporting technique, outcomes, and patient satisfaction. We evaluated our outcomes over a 5-year period looking at osseointegrated prosthetic reconstruction after auriculectomy for external ear skin malignancies. We report demographics, disease characteristics, technique, and complications. The patients were surveyed looking at 6 domains: satisfaction, stability, comfort, ease of use, level of self-consciousness, and preoperative education. Of the 21 patients included in the study, 14 (67%) were treated for invasive melanoma (Breslow depth, >0.8mm), 4 (19%) for squamous cell carcinoma, 2 (10%) for basal cell carcinoma, and 1 (5%) for an atypical fibroxanthoma. Complications rates were low. There were no cases of infection, hematoma, or bleeding. In 2 patients (9.5%), 1 of the 3 implants failed to osseointegrate and was removed, but the prosthesis was able to be secured with the remaining 2 posts. There were 3 cases (14%) of delayed healing and 1 with excessive granulation tissue growth. Survey results showed high satisfaction in all measured domains. In cases of skin malignancy requiring total or subtotal auriculectomy, prosthetic ear reconstruction with osseointegrated implants is a good alternative to reconstruction with autologous tissue. Our experience demonstrates good outcomes and with low complication rates and high patient satisfaction.

A Memory of Almost Nothing: Luc Ferrari’s Listening During Presque Rien No. 1

Luc Ferrari’s Presque rien, ou le lever du jour au bord de la mer (Almost nothing, or daybreak at the seashore) represents one of the most significant milestones in the development of field recording as it is understood today. His piece, recorded in 1968 in Vela Luka, is both a composition and an execution of auditory memory making. The work demonstrates the agentive capacity of Ferrari’s listening and sets a framework for future executions of the relational condition between human listening and the audition of the prosthetic ear: the microphone. In 2013, the author visited the same location to reconsider Ferrari’s sonic subjects and to update Ferrari’s exploration by expanding on the French composer’s listening methodologies.

Implant retained auricular prosthesis: A clinical report

Prosthetic ears are created for patients with microtia, a congenital defect that affects 1 in 10,000 births, as well as patients that have ears removed due to cancer and trauma. The current standard for ear prostheses is osseointegrated abutments and either magnets or bar clip prosthetic attachments. Osseointegration is a technology that grew out of the dental industry and was effectively translated to other prosthetic applications. Defects of the external ear could be corrected using prosthetic reconstructions retained by implants. Implant retained auricular prosthesis eliminates the need for the adhesives and provides better retention compared to the conventional prosthesis. Bar and clip design is currently followed for retaining the ear prosthesis. Bars are fixed onto osseointegrated craniofacial implants through a surgery. Clips embedded in an acrylic housing are used to retain the prosthesis on the bars. The major problems in this method are the bulk of prosthesis that compromises the final cosmetic outcome and the loosening of the clips. Although several reconstructive techniques exist for the auricular defect, the use of implants to anchor auricular prosthesis presents a suitable alternative. This article presents a case of a right auricular defect, which was congenital for which two bone-anchored implants were placed. Hader bar with ERA attachments was used for retention of the silicone auricular prosthesis.

PROSTHETIC EAR RECONSTRUCTION APPLYING COMPUTER TOMOGRAPHIC (CT) DATA AND ADDITIVE MANUFACTURING TECHNOLOGIES

The treatment of auricle defect can be by surgical or prosthetic ear rehabilitation depending on the condition. Current practice by surgeon for prosthetic ear rehabilitation require patient to go for osseointegrated craniofacial implant surgery for retention of the prosthetic ear. Impression technique play a vital role in accurate reproduction of affected and unaffected ears, orientation of the ear during wax try in and fabrication of ear prostheses. Traditionally, the wax pattern was created from the impression taken from patient and the final prosthesis is processed with silicone material. This conventional method has always been time consuming, massive work and caused discomfort to patient. Moreover the accuracy of the final prosthetic sometimes was not satisfied. Improvement in medical imaging technology whereby data from computerized tomography (CT) in 2D format can be converting to 3 dimensional images gave tremendous view for surgeon to visualize the result. A new and impressive advance in the development of additive manufacturing technology is now being able to be applied in medical field. The widespread use of computer-aided design (CAD) combine with computer aided manufacturing (CAM) produced the momentum and desire to translate the 3-D images into physical models. Studies and research have indicated the viability of using medical imaging technology, computer aided design (CAD) and additive manufacturing techniques in prosthetics. This paper proposed a novel method of fabricating the prosthetic ear applying mirror image technique to reconstruct the missing ear, and then fabricate the 3D model of the prosthetic ear using Stereolitography (SLA) technology that will become the master mold to produce the final prosthetic ear. This method eliminates the traditional wax pattern procedure. A clinical study is done onto a patient in HUSM and comparison is made between traditional method vs new approach using computer aided technology. Result showed that there is significant different between traditional and new approach design. The new method also shows time reduction during design and fabrication stage.

Improved Construction of Auricular Prosthesis by Digital Technologies.

Implant-retained auricular prostheses are a successful prosthetic treatment option for patients who are missing their ear(s) due to trauma, oncology, or birth defects. The prosthetic ear is aesthetically pleasing, composed of natural looking anatomical contours, shape, and texture along with good color that blends with surrounding existing skin. These outcomes can be optimized by the integration of digital technologies in the construction process. This report describes a sequential process of reconstructing a missing left ear by digital technologies. Two implants were planned for placement in the left mastoid region utilizing specialist biomedical software (Materialise, Belgium). The implant positions were determined underneath the thickest portion (of anti-helix area) left ear that is virtually simulated by means of mirror imaging of the right ear. A surgical stent recording the implant positions was constructed and used in implant fixtures placement. Implants were left for eight weeks, after which they were loaded with abutments and an irreversible silicone impression was taken to record their positions. The right existing ear was virtually segmented using the patient CT scan and then mirror imaged to produce a left ear, which was then printed using 3D printer (Z Corp, USA). The left ear was then duplicated in wax which was fitted over the defect side. Then, it was conventionally flasked. Skin color was digitalized using spectromatch skin color system (London, UK). The resultant silicone color was mixed as prescribed and then packed into the mold. The silicone was cured conventionally. Ear was trimmed and fitted and there was no need for any extrinsic coloring. The prosthetic ear was an exact match to the existing right ear in shape, skin color, and orientation due to the great advantages of technologies employed. Additionally, these technologies saved time and provided a base for reproducible results regardless of operator.

Ear prosthesis evaluation: specific absorption rate levels in the head due to different angles and frequencies of electromagnetic exposure

This study presents a numerical analysis of the specific absorption rate in a head model exposed to electromagnetic fields when a real implant-retained prosthetic ear is attached to the side of the head. A set of dipole antennas operating at 900, 1800 and 2100 MHz were rotated to investigate the effect of frequency and polarisation. The maximum average 1 and 10 g specific absorption rates (SAR) have been presented to show the relative enhancement factor of the implant. A comparison of the mass-averaged SAR in the head with the implanted ear prosthesis shows that the 1 g SAR is doubled at 900 and 1800 MHz with different polarisations.

Questions and Answers: Rating Auricular Avulsion Using the Sixth Edition

Question: Using the Sixth Edition, how would you rate a 49-year-old man who had a traumatic auricular (ear) avulsion and now has a prosthetic ear? I understand that this would be rated using Table 11-5, Criteria for Rating Impairment Due to Facial Disorders and/or Disfigurement (6th ed, 262), and that history is the key factor. I do not know how to consider the impact of the prosthesis and what class to put this patient in. Section 2.4e, Using Assistive Devices in Evaluations (6th ed, 25), provides guidance, but it is not directly applicable to auricular loss. The patient has no interference with activities of daily living and no hearing impairment. A prior physician rated the patient at 0% whole person impairment (WPI) and then rerated him at 20% WPI.Answer: Loss of the pinna (visible external ear) is rated using Chapter 11, Ear, Nose, Throat, and Related Structures. Chapter 8, The Skin, specifies, “Facial disfigurement is rated in Chapter 11 (Table 11-5)” (6th ed, 162). The disfigurement is disguised by the prosthetic ear and there is no significant interference in activities of daily living. As opposed to visible deformity of the front of the face, which cannot be adequately disguised, the location of the ear is more consistent with the descriptions of severe disfigurement above the brow line (limited to 1% WPI) or below the upper lip (limited to 8% WPI) on page 261.If Table 11-5 (6th ed, 262) is used, history is the key factor, and the assignment would be class 1, ie, “Facial abnormality involving only cutaneous structures with highly visible scar and/or abnormal pigmentation. No activities of daily living, including breathing or eating, are affected,” with a default impairment of 3% WPI. Assuming the scar is small and the cosmetic ear looks reasonably similar to his other ear, and assuming he has no hearing deficit, physical examination could be as low as class 0. Diagnostic or other objective findings would be considered as “not applicable.” With the physical examination being 1 class lower than history, there is adjustment downward to 1% WPI.However, if the cosmetic external ear is clearly noticeable, and if the person is aware in social circumstances that the ear looks noticeably different to others, the examiner could chose class 1 (“significantly visible scar and/or abnormal pigmentation”). This would make the net adjustment equal 0, and the final rating would be from class 1, Grade B, or 3% WPI.Section 2.4e, Using Assistive Devices in Evaluations (6th ed, 25), advises that, “If an individual must regularly use a prosthesis, orthosis, or other assistive device, the physician should test and evaluate the organ system with the device. However, if the assistive device is easily removable, the examiner may choose also to test without the assistive device in place and then report both sets of results.” In this case, the prosthesis is cosmetic and does not affect function. It decreases the disfigurement, and thus decreases the impact of the pinna amputation on social function, but there is no “test” to do with and without the prosthesis.

Photogrammetric Scanning Technique and Rapid Prototyping Used for Prostheses and Ortheses Fabrication

Paper approaches the feasibility of manufacturing of some types of prostheses and ortheses by using the photogrammetric scanning technique, 3D reconstruction of anatomic surfaces and Rapid Prototyping with 3D printers. Photogrammetric scanning appears to be the most cost effective technique but has some limitations in the reconstruction of anatomic surfaces. There are presented and discussed the processing steps used in the fabrication of a foot orthesis and of a prosthetic ear.

Prosthetic rehabilitation of partial ear loss with custom-made acrylic attachment and long-term soft liner

The craniofacial implants are used for retaining the prostheses although these are costly and often require complex laboratory procedures. The aim of this case report is to describe a case of successful rehabilitation of partial ear loss with long-term soft liner and mechanically retained by custom-made heat-cured acrylic attachment. A female patient underwent a scalp avulsion injury and lost major portion of her hair and upper part of the left ear till the antitragus. A partial auricular prosthesis was fabricated, and mechanical retention was achieved through custom-made heat-cured acrylic attachment engaged in anatomic undercuts of remained ear. Permanent soft liner provided a life-like appearance and consistency to the prosthetic ear and bonded to custom-made heat-cured acrylic attachment through chemical cross-linking. Patient accepted the prosthesis satisfactorily without any social and psychological embracement. This technique simplified the clinical and laboratory procedures and reduced the cost of the prosthesis.

Osseointegration Technique in Patients with Acquired Auricular Deformities and Failed Previous Reconstruction: A Retrospective Study of Long-Term Follow-Up and Chinese Experience

Objectives: To evaluate the complication rate and patient satisfaction of reconstruction of acquired auricular deformities and failed previous reconstruction by the osseointegration technique. Methods: The study enrolled 24 patients from January 2002 to December 2005. Data collected included demographic information, success rate of auricular prostheses, site of implants, survival rate of implants, occurrence of skin reaction and condition of the prosthetic ear. Results: Twenty-five ears (24 patients) were implanted. All ears were healing well with a lifelike appearance, stable fixation and natural color; except for 2 instances of implants dislocated by trauma, the rest survived well by first intention; skin reaction was the most troublesome complication, no patient was able to maintain a consistent level of soft-tissue health for the whole follow-up period, but the ratio and degree of skin reaction decreased gradually. The time of wearing prosthetic ears was more than 8 h/day. The average time length until prosthetic ear replacement was 3.5 years. There were no intracranial or systemic complications. Conclusion: The osseointegration technique can be the method of choice for acquired auricular defects and failed reconstructions. Follow-up management is important to the health of the implants and the surrounding soft tissue and to preserve the prosthesis and its retention mechanism.

Prosthodontic rehabilitation of hemifacial microsomia

Hemifacial microsomia, a developmental anomaly involving the first and second branchial arches, is one of the most common craniofacial anomalies. This disorder affects orofacial structures with varying clinical features. It is also associated with underdevelopment of the temporomandibular joint, mandibular ramus, masticatory muscles, ears, and occasionally defects in facial nerve and muscles. Physical deformities affecting face, ears, eyes, and oral cavity can pose esthetic and functional problems. The rehabilitation of these patients should be multidisciplinary including prosthodontic management as these patients present with complex clinical features. Treatment approach depends on patient's age, extent of physical and psychological deformity. The fabrication of auricular prosthesis is considered to be one of the most difficult replacements in maxillofacial rehabilitation. The severe undercuts and pronounced convolutions of the ear's surface present a challenge in simulating a natural proportioned prosthesis. This paper presents an outline in basic fabrication of prosthetic ear by conventional technique where the wax pattern is fabricated from the impression of an individual with a similarly proportioned ear.