Stable Outcomes Research Articles

Comparison of mesiodistal root angulation of teeth by conventional panoramic and cone beam computed tomography images – A cross-sectional study

Accurate bracket positioning is required for proper root parallelism and for stable orthodontic treatment outcomes. This study aimed to determine the difference in mesiodistal root angulation of teeth measured on three radiographic images. A cross-sectional study was conducted using orthopantomogram (OPG), panoramic images of cone beam computed tomography (Pan-CBCT) and cone beam computed tomography (CBCT). An occlusal plane was constructed in OPG and Pan-CBCT for angular measurements. The axial and sagittal views were used for assessing the mesiodistal root angulation on CBCT. Mesiodistal root angulation differences among three radiographs were assessed using the Kruskal-Wallis test. Mann-Whitney U test was applied for pairwise comparison and multinomial logistic regression was used to determine the association of sexual dimorphism with the direction of root angulation. On comparing the mesiodistal root angulation in degrees (DE) among all three groups, upper right (UR2) and left lateral incisors (UL2) were found to be statistically significant with P=0.033 and P=0.050 respectively. On pair-wise comparison, we found a statistically significant difference for upper right lateral incisor (UR2) between OPG and Pan-CBCT (P=0.045). Upper left lateral (UL2) (P=0.024) was significant in OPG and Pan-CBCT while upper left first molar (UL6) (P=0.043) in OPG and CBCT group. On comparing the sexual dimorphism in the direction of root angulation, females showed a greater tendency of mesial root angulation (5.62) times for upper right second premolar (UR5) as compared to males. There were no significant difference in mesiodistal root angulation between panoramic CBCT and CBCT images. The angulation of the upper lateral incisors was found to be significant between OPG and panoramic CBCT images, whereas the angulation of the upper right lateral incisors and left first molars was significant between OPG and CBCT images. In terms on sexual dimorphism, females showed greater mesial angulation of teeth than males.

Socket Shield Technique and Immediate Implant Placement – A Systematic Review

<p>Purpose: A novel method, socket shield technique (SST), preserving the peri-implant tissue dimensions by retaining the buccal aspect of root was published by Hurzeler et al in 2010. Our study aims to compare the clinical and radiographic outcomes between conventional immediate implantation and socket shield technique (SST) based on prospective clinical trials. Also, we will discuss the different protocols and modifications of the socket shield technique. Material and methods: A PubMed, Cochrane Library, Embase database search was conducted to identify relevant publication up to March 2022. Result: 7 articles were included in our systemic review. The follow-up periods of the included literature ranged from 6 months to 4 years and contained 106 cases of socket shield technique (Test group) and 112 cases of conventional immediate implantation technique (Control group). None of the implants failed to have osseointegration. The horizontal bone loss at the crestal area in test group and control group ranged from 0.12~0.29mm and 0.29~1.45mm half a year post-operatively on CBCT, respectively. On the other hand, the vertical bone loss in test group and control group ranged from 0.28~0.36mm and 0.77~1.71mm half a year after operation on CBCT. All the results showed the socket shield techniques had less tissue alterations compared to the conventional immediate implantation with statistical significance. The overall Pink Esthetic Score (PES) of the test group (Socket shield technique) in the included studies ranged from 12.0 to 13.25 postoperatively, comparing to those ranging from 8.85 to 12.60 for the control group. Conclusion: All the included clinical trials showed promising results of socket shield technique in respect of less bone and soft tissue volume changes than the conventional immediate implantation. However, it is still unclear whether the socket shield technique will provide a stable long-term outcome in this stage.</p> <p> </p>

Epidemiological evidence and association of human papillomavirus with esophageal cancer in northeastern Thailand: a case-control study.

Recently, epidemiological evidence of high-risk human papillomavirus (hrHPV) and its association with the increasing risk of esophageal cancer (EC) have been described. However, the involvement of such a virus in the pathogenesis of EC is still inconclusive in the literature. Therefore, our objective was to clarify the epidemiology of HPV infections in primarily diagnosed EC cases and validate this correlation with hospital-based control patients using a retrospective study with a case-control model. Here, we reported that the overall prevalence of HPV DNA was statistically associated with an increased risk of EC (OR, 3.3; 95% CI, 2.5-4.3). Interestingly, a history of gastroesophageal reflux disease (GERD) was constituted and significantly associated with HPV prevalence (adjusted OR, 4.6; 95% CI, 2.2-9.5). Furthermore, our meta-analysis in public databases also indicated that the combined OR and 95% CI between HPV infection and EC risk were 3.31 and 2.53-4.34, respectively, with significant heterogeneity (I2 = 78%). Variations in the geographic study, tissue type, and detection method remain potential predictors of heterogeneity. In addition, publication bias and sensitivity analysis were not observed, and the results exhibited stable outcomes. Collectively, we specify the recent epidemiological evidence in a validation of the distributed HPV, which might be statistically associated with an increased risk of EC. However, additional high-quality studies with larger sample sizes are needed to further verify the link between HPV and EC.

Comprehensive Smile Makeover: A Case Report and 1 Year Follow up

Introduction: Dental Fluorosis is one of the common reasons of an unesthetic smile affecting confidence of patient. Depending upon the duration and exposure to fluoride, it can be mild, moderate or severe.
 Case Report: The present case report aimed to rehabilitate esthetically a patient with fluorosis, rotated teeth and spacing in maxillary anterior region using a conservative approach.
 Results: The post-operative esthetic appearance of the patient was enhanced and follow up to one year showed acceptable and stable esthetic outcomes.
 Conclusion: Though, there are various treatment modalities available for esthetic makeovers, accurate diagnosis, diligent treatment planning and choice of available materials can lead to better esthetic results.

An Electrochemical Screen-Printed Sensor Based on Gold-Nanoparticle-Decorated Reduced Graphene Oxide-Carbon Nanotubes Composites for the Determination of 17-β Estradiol.

In this study, a screen-printed electrode (SPE) modified with gold-nanoparticle-decorated reduced graphene oxide-carbon nanotubes (rGO-AuNPs/CNT/SPE) was used for the determination of estradiol (E2). The AuNPs were produced through an eco-friendly method utilising plant extract, eliminating the need for severe chemicals, and remove the requirements of sophisticated fabrication methods and tedious procedures. In addition, rGO-AuNP serves as a dispersant for the CNT to improve the dispersion stability of CNTs. The composite material, rGO-AuNPs/CNT, underwent characterisation through scanning electron microscopy (SEM), ultraviolet-visible absorption spectroscopy (UV-vis), Fourier-transform infrared (FTIR) spectroscopy, and atomic force microscopy (AFM). The electrochemical performance of the modified SPE for estradiol oxidation was characterised using cyclic voltammetry (CV) and differential pulse voltammetry (DPV) techniques. The rGO-AuNPs/CNT/SPE exhibited a notable improvement compared to bare/SPE and GO-CNT/SPE, as evidenced by the relative peak currents. Additionally, we employed a baseline correction algorithm to accurately adjust the sensor response while eliminating extraneous background components that are typically present in voltammetric experiments. The optimised estradiol sensor offers linear sensitivity from 0.05-1.00 µM, with a detection limit of 3 nM based on three times the standard deviation (3δ). Notably, this sensing approach yields stable, repeatable, and reproducible outcomes. Assessment of drinking water samples indicated an average recovery rate of 97.5% for samples enriched with E2 at concentrations as low as 0.5 µM%, accompanied by only a modest coefficient of variation (%CV) value of 2.7%.

Leader Turnover, Regime Type, and Growth Volatility

AbstractHow do leaders influence national-level economic outcomes? We address this question by considering how leadership turnover influences volatility in economic growth. In doing so, we theorize that leaders from mixed regimes will reduce economic volatility due to domestic political incentives to create stable economic outcomes. Furthermore, we decompose the influence of leaders in non-democratic regimes and argue that leaders in party-based authoritarian regimes will also reduce economic volatility. To test our hypotheses, we focus on the effect of leadership turnover due to natural leader death to control for issues of endogeneity. We find that leaders in mixed regimes reduce volatility more than leaders in autocratic and democratic regimes and that leaders in party-based authoritarian regimes reduce volatility more than those in military or monarchy-based regimes. We conclude by explaining the implications of our findings for the study of leaders in international politics and their impact on economic growth and development.

ONE CORNEA TWO RECIPIENTS: FEEDING TWO BIRDS WITH ONE SCONE

The existing shortage of local donor corneas in our institution (University Malaya) and Malaysia, in general, prompted us to attempt the use of one donor cornea for two transplantation procedures; Descemet Stripping Endothelial Keratoplasty (DSEK) in a case of a pseudophakic bullous keratopathy (PBK) with underlying Fuchs endothelial dystrophy (FED) and lamellar patch graft in a case of limbal dermoid. The donor cornea was divided into anterior and posterior lamellae manually. The anterior corneal button was used as a patch graft for anterior lamellar keratoplasty in a 6-year-old patient with limbal dermoid, and the posterior corneal button was used for a DSEK procedure in a 68-year-old patient with corneal decompensation. Both patients had a stable and good visual outcome throughout a 1-year postoperative period. This allows the use of one corneal tissue by more than one recipient to overcome the shortage in donor corneas.

Complexity of stability in trading networks

Efficient computability is an important property of solution concepts. We consider the computational complexity of finding and verifying various solution concepts in trading networks—multi-sided matching markets with bilateral contracts and without transferable utility—under the assumption of full substitutability of agents’ preferences. It is known that outcomes that satisfy trail stability always exist and can be found in linear time. However, we show that the existence of stable outcomes—immune to deviations by arbitrary sets of agents—is an {{textsf{N}}}{{textsf{P}}}-hard problem in trading networks. We also show that even verifying whether a given outcome is stable is {{textsf{N}}}{{textsf{P}}}-hard in trading networks.

Effectiveness of Thermal Barrier Bag for Prolonged Vascular Anastomosis in Kidney Transplantation

In kidney transplantation (KT), efforts to minimize rewarming and optimize anastomosis time during vascular anastomosis improve graft outcomes. We recently reported the safety and efficacy of a pouch-type thermal barrier bag (TBB) made of elastomer gel to reduce second-warm ischemic injury during vascular anastomosis. We aimed to examine the usefulness of the TBB in prolonged vascular anastomosis in KT performed by young transplant fellows. Young transplant fellows performed KT under the supervision of certified transplant surgeons. The kidney graft was placed inside the TBB with an outlet for vessels and preserved during vascular anastomosis. A non-contact infrared thermometer measured the graft surface temperature before and after vascular anastomosis. After completion of the anastomosis, the TBB was manually slid out of the transplanted kidney and removed before graft reperfusion. Clinical data, including patient characteristics and perioperative variables, were collected. The primary endpoint was the median graft surface temperature at the end of the anastomosis. Ten living-donor kidney transplant recipients with a median age of 56.5 years (range, 40-69 years) underwent KT procedures performed by young transplant fellows. The median anastomosis time was 53 (43-67) min. At the end of anastomosis, the median graft surface temperature was 17.7°C (16.3-18.3°C); no serious adverse events or delayed graft function were observed. The TBB can keep transplanted kidneys at a low temperature even with prolonged vascular anastomosis time, thus contributing to the functional preservation of transplanted kidneys and stable transplant outcomes.

Infra-occluded primary molars: diagnosis and management

Infra-occluded primary molars can be challenging in terms of their surgical management and potential sequelae. The prognosis of these teeth needs to considered allowing treatment planning for a stable long-term outcome for the patient. This article outlines the key principles to consider following a diagnosis of an infra-occluded primary molar, and it provides a management tool to aid decision making. CPD/Clinical Relevance: Timely diagnosis and management of infra-occluded primary molars is vital within the overall care pathway for these patients.

Multichannel Sparse Deconvolution of Teleseismic Receiver Functions With f − x Preconditioning

AbstractTeleseismic receiver functions (RFs) are an effective tool for structural imaging due to their simplicity and sensitivity to changes in rock elastic properties. Generally, RFs are estimated through trace‐by‐trace deconvolution. This individualized approach ignores the lateral coherency among RFs from neighboring raypaths, which could lead to rougher or incorrect seismic sections due to the presence of noise. This study presents a multichannel sparse deconvolution method that takes advantage of the cross‐trace coherency of RFs at individual stations for stable and accurate imaging outcomes. The proposed algorithm incorporates sparse inversion and frequency‐space prediction filters, which facilitate the retrieval of high‐resolution and spatially continuous conversion energy. Rigorous testing using synthetic and actual data typically suggests the higher robustness of multichannel deconvolution over single‐channel deconvolution, especially under low signal‐to‐noise ratios. The noise‐resistance property of the multichannel approach offers new opportunities to increase the volume of usable, high‐quality data for receiver function analysis.

Precision shaping of elastic stable intramedullary nail for the treatment of metaphyseal diaphysis junction fracture of the distal radius in children: a preliminary report in two centers

BackgroundThis study introduces a novel retrograde precision shaping elastic stable intramedullary nailing (ESIN-RPS) technique and reports clinical outcomes in pediatric distal radius metaphyseal diaphysis junction (DRMDJ) fracture.MethodsData about DRMDJs were collected from February 1, 2020, to April 31, 2022 at two hospitals, retrospectively. All patients were treated with closed reduction and ESIN-RPS fixation. The operation time, blood loss, fluoroscopy times, alignment, and residual angulation on X-ray were recorded. At the last follow-up, the function of wrist and forearm rotation were evaluated.ResultsTotally, 23 patients were recruited. The mean time of follow-up was 11 months and the minimum was 6 months. The mean operation time was 52 min, and the mean fluoroscopies pulses were 6 times. The postoperative anterioposterior (AP) alignment was 93 ± 4% and the lateral alignment was 95 ± 3%. The postoperative AP angulation was (4 ± 1)°, and the lateral angulation was (3 ± 1)°. At the last follow-up, the evaluation of the Gartland and Werley demerit criteria of wrist revealed 22 excellent cases and 1 good case. The forearm rotation and thumb dorsiflexion functions were not limited.ConclusionThe ESIN-RPS is a novel, safe, and effective method for the treatment of pediatric DRMDJ fracture.

Efficacy of Intraoperative Neuromonitoring during the Treatment of Cervical Myelopathy

Abstract Objective The accuracy of intraoperative neuromonitoring (IONM) during surgery for cervical spondylotic myelopathy (CSM) to detect iatrogenic nervous system injuries while they are reversible remains unknown. We evaluated a cohort of patients who had IONM during surgery to assess accuracy. Methods Patients who underwent surgical treatment of CSM that included IONM from January 2018 through August 2018 were retrospectively identified. A standardized protocol was used for operative management. Clinical changes and postoperative neurological deficits were evaluated. Results Among 131 patients in whom IONM was used during their procedure, 42 patients (age 58.2 ± 16.3 years, 54.8% males) showed IONM changes and 89 patients had no change. The reasons for IONM changes varied, and some patients had changes detected via multiple modalities: electromyography (n = 25, 59.5%), somatosensory-evoked potentials (n = 14, 33.3%), motor evoked potentials (n = 13, 31.0%). Three patients, all having baseline deficits before surgery, had postoperative deficits. Among the 89 patients without an IONM change, 4 showed worsened postoperative deficits, which were also seen at last follow-up. The sensitivity of IONM for predicting postoperative neurological change was 42.86% and the specificity was 68.55%. However, most patients (124, 94.7%) in whom IONM was used showed no worsened neurological deficit. Conclusion IONM shows potential in ensuring stable postoperative neurological outcomes in most patients; however, its clinical use and supportive guidelines remain controversial. In our series, prediction of neurological deficits was poor in contrast to some previous studies. Further refinement of clinical and electrophysiological variables is needed to uniformly predict postoperative neurological outcomes.

Benefits of the PRISM Shelter-Based Program for Attainment of Stable Housing and Functional Outcomes by People Experiencing Homelessness and Mental Illness: A Quantitative Analysis.

To explore the housing trajectory, personal recovery, functional level, and quality of life of clients at discharge and 1 year after completing Projet Réaffiliation Itinérance Santé Mentale (PRISM), a shelter-based mental health and rehabilitation program intended to provide individuals experiencing homelessness and severe mental illness with transition housing and to reconnect them with mental health and social services. Housing status, psychiatric follow-up trajectory, personal recovery (Canadian Personal Recovery Outcome Measure), functional level (Multnomah Community Ability Scale), and quality of life (Lehman Quality of Life Interview) were assessed at program entry, at program discharge and 1 year later. Of the 50 clients who participated in the study from May 31, 2018, to December 31, 2019, 43 completed the program. Of these, 76.7% were discharged to housing modalities and 78% were engaged with psychiatric follow-up at the program's end. Housing stability, defined as residing at the same permanent address since discharge, was achieved for 62.5% of participants at 1-year follow-up. Functional level and quality of life scores improved significantly both at discharge and at 1-year follow-up from baseline. Admission to PRISM helped clients secure long-term stable housing and appropriate psychiatric follow-up. Stable housing was maintained for most clients at 1-year follow-up, and they benefited from sustained functional and quality of life outcomes in long-term follow-up.

Laser in situ keratomileusis versus Artisan lens implantation in correcting ametropia after penetrating keratoplasty for keratoconus

PurposeTo compare the long-term safety and efficacy of laser in situ keratomileusis (LASIK) with Artisan phakic intraocular lens implantation to correct refractive errors after penetrating keratoplasty (PK) for keratoconus.MethodsThis retrospective comparative interventional case series included a total of 33 consecutive keratoconus eyes that had previous PK and received subsequent LASIK (n = 16) or Artisan lens implantation (n = 17) were included in this study. Outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, and complications.ResultsPostoperatively, the UDVA of ≥20/40 was achieved in none of the LASIK group compared to 62.5% of eyes in the Artisan group (P < 0.001); the respective values for CDVA of ≥20/40 were 87.5 and 94.1% (P = 0.51). Spherical equivalent refraction decreased from − 6.97 ± 1.50 D preoperatively to − 4.20 ± 2.05 D postoperatively in the LASIK group (P < 0.001) and from − 10.79 ± 2.15 D preoperatively to − 2.13 ± 1.23 D postoperatively in the Artisan group (P < 0.001). There was no significant change in the refractive astigmatism in LASIK group (P = 0.30) or Artisan group (P = 0.11). The efficacy and safety indices were significantly better for Artisan (0.82 ± 0.34 and 1.13 ± 0.30, respectively) than for LASIK (0.22 ± 0.17 and 0.85 ± 0.24, respectively, P ≤ 0.006 for both comparisons). While refractive error changed significantly from postoperative year 3 to the final visit in the LASIK group, it remained stable in the Artisan group through follow-up period. No significant complications were observed in any group.ConclusionArtisan lens implantation provided superior and stable visual outcomes compared to LASIK for the management of post PK refractive errors in keratoconus eyes.

Panuveitis of undetermined origin after diagnostic pars plana vitrectomy: clinical characterization and long-term outcome from a tertiary referral center.

To identify the characteristics and outcome of panuveitis of undetermined origin (PUO) after diagnostic vitrectomy. Retrospective analysis of all patients who underwent vitrectomy for diagnostic/therapeutic purposes from 2013 to 2020, whose vitreous biopsies turned out negative and final diagnoses were not clinically supported. Of 122 operated eyes, 36 eyes (29.5%) were defined as PUO (67.8 ± 14.9years). The presenting clinical picture revealed a predominantly bilateral condition (70% of eyes) with significant posterior segment involvement: 3.1 ± 0.6 vitritis, 61.1% of eyes with retinal vasculitis, 44.4% with macular edema, and 30.6% with exudative retinal detachment. Presenting visual acuity was 1.2 ± 0.7 logMAR, and up to 90% remained stable or improved vision over a ~ 3.5year observation period. None of the presenting clinical features turned out to be predictive of final visual outcome or survival. PUO is present in up to 30% of cases after diagnostic/therapeutic vitrectomy. This mainly bilateral condition shows chronic and overall stable long-term outcome, generally with retained steady visual function.

Epiretinal Amniotic Membrane in Complicated Retinal Detachment: a Clinical and In Vitro Safety Assessment.

Amniotic membrane (AM) is a popular treatment for external ocular diseases. First intraocular implantations in other diseases reported promising results. Here, we review three cases of intravitreal epiretinal human AM (iehAM) transplantation as an adjunct treatment for complicated retinal detachment and analyze clinical safety. Possible cellular rejection reactions against the explanted iehAM were evaluated and its influence was assessed on three retinal cell lines in vitro. Three patients with complicated retinal detachment and implanted iehAM during pars plana vitrectomy are retrospectively presented. After removal of the iehAM at subsequent surgery, tissue-specific cellular responses were studied by light microscopy and immunohistochemical staining. We investigated the influence of AM in vitro on retinal pigment epithelial cells (ARPE-19), Müller cells (Mio-M1), and differentiated retinal neuroblasts (661W) . An anti-histone DNA ELISA for cell apoptosis, a BrdU ELISA for cell proliferation, a WST-1 assay for cell viability, and a live/dead assay for cell death were performed. Despite the severity of the retinal detachment, stable clinical outcomes were obtained in all three cases. Immunostaining of the explanted iehAM showed no evidence of cellular immunological rejection. In vitro, there was no statistical significant change in cell death or cell viability nor were proliferative effects detected on ARPE-19, Müller cells, and retinal neuroblasts exposed to AM. iehAM was a viable adjuvant with many potential benefits for treatment of complicated retinal detachment. Our investigations could not detect any signs of rejection reactions or toxicity. Further studies are needed to evaluate this potential in more detail.

X-linked hypophosphatemic rickets: cases series and literature review with a focus on neurosurgical management

X-linked hypophosphatemic rickets (XLH) is an X-linked dominant disease caused by mutations in the Phosphate-Regulating Endopeptidase X-Linked (PHEX) gene. Due to its rarity and the wide range of clinical manifestations, management of the disease can be challenging due to several associated clinical implications that may arise during follow-up. The neurological complications associated with XLH are the most severe and often less known, which lead to important comorbidities. With the aim of summarizing the available knowledge on neurosurgical intervention in patients with XLH, we present four emblematic cases with disorders requiring neurosurgical evaluation. Relevant diagnostic delay was seen in two of these cases, with another case demonstrating that complications requiring neurosurgery may be present even in patients with few symptoms. The last case stresses the need for care of adult patients who can present with undiagnosed comorbidities. We also carried out a narrative review on neurosurgical interventions in patients with XLH. Through case reports and a review of the literature, focus is placed on the role of the neurosurgeon in the management of patients with XLH. In fact, neurosurgical intervention can often provide stable outcomes for craniosynostosis and clinical improvement for symptoms related to spinal stenosis. Thus, the neurosurgeon can aid in optimizing management of patients with XLH and should be a member of both adult and pediatric multidisciplinary teams. Lastly, additional studies are needed to determine if the early use of burosumab in infants can help to avoid complications in the long term.

Evolution and simulation of drug safety regulations: construction of a game model for capture event

PurposeThe study focuses on drug safety regulation capture, reveals the inner mechanism and evolutionary characteristics of drug safety regulation capture and provides suggestions for effective regulation by pharmacovigilance.Design/methodology/approachThe article introduces prospect theory into the game strategy analysis of drug safety events, constructs a benefit perception matrix based on psychological perception and analyzes the risk selection strategies and constraints on stable outcomes for both drug companies and drug regulatory authorities. Moreover, simulation was used to analyze the choice of results of different parameters on the game strategy.FindingsThe results found that the system does not have a stable equilibrium strategy under the role of cognitive psychology. The risk transfer coefficient, penalty cost, risk loss, regulatory benefit, regulatory success probability and risk discount coefficient directly acted in the direction of system evolution toward the system stable strategy. There is a critical effect on the behavioral strategies of drug manufacturers and drug supervisors, which exceeds a certain intensity before the behavioral strategies in repeated games tend to stabilize.Originality/valueIn this article, the authors constructed the perceived benefit matrix through the prospect value function to analyze the behavioral evolution game strategies of drug companies and FDA in the regulatory process, and to evaluate the evolution law of each factor.

Microtia Reconstruction: Our Strategies to Improve the Outcomes.

Introduction : Autologous costal cartilage framework placement is currently the gold standard in patients with microtia. In this article, we present the modifications developed by the author, generally following the principles established by Nagata, and discuss the technical details that have led us to achieve consistently stable and good long-term outcomes for auricular reconstruction in microtia. Materials and Methods : A retrospective review of microtia reconstruction performed from 2015 to 2021 was done. Those who underwent primary reconstruction for microtia and with a minimum follow-up of 6 months with documented photographs were included. Those who underwent secondary reconstruction for microtia and those who did not follow-up for a minimum period of 6 months were excluded. Outcomes were assessed with regard to appearance, and durability of the result. Influence of certain changes like delaying reconstruction until 15 years of age, use of nylon for framework fabrication, etc. over the outcome were assessed. Results : Of 11 ears reconstructed at less than 15 years of age, only one patient (9%) had a good long-term outcome, whereas of the 17 ears reconstructed at greater than 15 years of age, nine patients (53%) had a good long-term outcome. In our experience, infections and wire extrusions were the significant events related to severe cartilage resorption. Conclusion : In our experience, delaying the first stage to 15 years or later, using double-armed nylon sutures, and reducing the projection of the third layer of the framework in select cases have helped to improve our outcomes. Second stage of reconstruction can be avoided if patient is satisfied with the projection achieved in the first stage.