Auricular prosthesis is the oldest technique for ear reconstruction. There are still some good indications to perform this procedure despite the progress in reconstruction with autologous rib cartilage.
Surgeons who regularly perform ear reconstruction must recognize when to propose a prosthetic solution. They must be able to perform themselves placement of the intraosseous implants needed to anchor the prosthesis. The result relies on the correct positioning of these implants and the quality of the prosthesis performed by the anaplastologist.
In cases of poor local tissue conditions, patients should be informed that an autologous ear reconstruction may fail, and that a prosthesis could become the appropriate solution. Patients should be given all the information regarding the risks of a prosthesis.
INDICATIONS
There are different circumstances when the reconstruction with autologous cartilage will not be the best choice. Usually it is when local skin potential is not sufficient to cover a three-dimensional cartilaginous framework. Other indications include the following:
Posttraumatic cases with scars in the auricular area and a damaged superficial temporal artery
Secondary microtia with poor local tissue conditions and damaged superficial temporal and occipital arteries
Desire of the patient disappointed with the result and who does not want to consider a new reconstruction with autologous cartilage harvested from the contralateral side
Failure of a reconstruction performed in difficult local conditions
Elderly patients
Posttraumatic Cases
In some cases the cartilaginous framework cannot be covered except with a contralateral free temporofascial flap. However, many patients accept the solution of a prosthesis and a wig.
During the initial consultation, the local conditions should be precisely analyzed to determine whether fascia surrounding the ear can be used; the surgeon must consider the circumstances and previous surgery. The native tragus is frequently present even after total amputation of the ear and can very conveniently hide the anterior border of the prosthesis.
Microtia Secondary Cases
For secondary cases, a new autologous ear reconstruction may be an option (see Chapter 8), in which cartilage is harvested from the contralateral side. However, the prosthetic option should always be discussed with the patient. In some cases the only choices to consider are free flaps, which are not our preferred choice because of the high complication rate.
Patients Not Motivated Even if a New Reconstruction Is Possible
Failure of a Reconstruction Performed in Difficult Local Tissue Conditions
Local conditions may compromise the possibility of ear reconstruction. Patients who are informed about the risk of failure and are still motivated should also be informed that a prosthesis is a possible solution in case of failure.
Only gold members can continue reading. Log In or Register to continue