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| CASE REPORT |
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| Year : 2014 | Volume
: 4
| Issue : 2 | Page : 97-100 |
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Auricular prosthesis: A rare case report
Poonam K Khinnavar, Charu Gupta
Department of Prosthodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| Date of Web Publication | 11-Sep-2015 |
Correspondence Address:
Poonam K Khinnavar
Department of Prosthodontics, Bapuji Dental College and Hospital, Davangere, Karnataka
India
 Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.  | Check |
DOI: 10.4103/2231-6027.165099
This case report describes an alternative to surgical reconstruction of the ear using silicon rubber material in a 37-year-old female patient, who had an external defect in the pinna. The affected region was the scapha portion of the external ear. This prosthesis is cost-effective and cosmetically accepted to improve the quality of life. Keywords: Auricle, pinna, prosthesis, scapha
How to cite this article:
Khinnavar PK, Gupta C. Auricular prosthesis: A rare case report. Int J Oral Health Sci 2014;4:97-100 |
| Introduction | |  |
Maxillofacial prosthesis involves rehabilitation of patients with defects or disabilities that were present congenitally or acquired due to disease or trauma. Prostheses are often needed to replace missing areas of bone or tissue and restore oral functions such as swallowing, speech, and chewing. In other instances, prosthesis for the face or body may be indicated for cosmetic and psychosocial reasons. Though Auricular rehabilitation can be successfully achieved by surgical reconstruction or prosthetic replacement, with the evolution of dental materials and techniques, prosthetic replacement is gaining high popularity. Prosthetic replacement is advantageous over surgical as it is comparatively cheap, possible to re-evaluate, hygienic, and color, size, and shape can be easily manipulated by the clinician.
Traditionally, the acrylic resin had been the material of choice for fabrication of the auricular prosthesis, as it is an economically viable treatment option. Recently, there has been immense progress in the field of maxillofacial prosthetics and the introduction of the silicone-based materials has enabled the clinicians to provide quality health care to the patients in need.[1] It has proved superior to acrylic in terms of patient's adaptation, shade matching, texture, and esthetics. Disadvantages being it requires adhesives for retention, irritation at the involved site and requires regular recall.[2],[3]
| Case Report | | |
A 33-year-old female patient reported to the Department of Prosthodontics including crown and bridge, Bapuji Dental College and Hospital, Davangere with a chief complaint of congenitally missing part of her left ear. She had never undergone any surgical treatment for the defect.
On clinical examination, part of the pinna (scapha) of the left ear was missing, without any associated hearing defect. The patient was educated and counseled about the prosthesis, and detailed consent form was obtained.
A preliminary impression was made for both the ears using alginate following standard procedures. While making an impression, facial skin and hair surrounding ear was protected with petroleum jelly, and the auditory canal was blocked with a cotton roll. The impression was poured using Type IV and Type III dental stone.
The obtained cast was assessed properly for any defect, before the wax up. Patient's contralateral ear was measured for all required dimensions and wax up was done for the defective ear as a mirror image of the natural ear [Figure 1]. The waxed up prosthesis was tried on the patient and was thoroughly assessed for proper orientation superoinferiorly and anterior-posteriorly. Patient's acceptance was taken regarding any modifications.
Final polishing of the waxed up prosthesis was done on the cast and finished pattern was sealed properly. The wax pattern was ready to be invested, after the first pour with Type II gypsum, 6–7 holes were made for proper orientation during packing. Second pour was done using Type III stone. Dewaxing was done using hot water bath under standard specifications [Figure 2].
Before packing, shade selection was done. Basic stains (red, yellow, white, brown) of vulcanizing silicone were mixed and were matched with the affected ear and the contralateral side till the nearest possible match. Separate shades were selected for different parts of the ear. After final shade selection, packing with selected silicone shade was done, and the flask was again approximated using orientation grooves [Figure 3]. After curing, the flask was opened, and the prosthesis was critically evaluated for any defect before trimming the excess.
The final prosthesis was tried on the patient. Bioadhesive® was used to attach the prosthesis to the ear [Figure 4]. A bioadhesive contains a resin which acts as a tackifier and an oxyalkylene polymer having a silicon-containing group which can be crosslinked by forming a siloxane bond.
The patient was instructed regarding the usage of the prosthesis. Application of the adhesive after every 24 h, regular cleaning of the prosthesis with lauryl sulfate solution and to limit the sun exposure to avoid discoloration of silicone material. A recall check-up was done after 6 months, and the patient was happy and satisfied with the present prosthesis [Figure 5].
| Discussion | | |
Irrespective of the cause, abnormalities in shape, size, and position of body organs are often perceived as looking wrong. This perception can subject the individual to significant social ostracism. Rehabilitation of patients with auricular defects can either be done by reconstructive surgery or by prosthetic means.[4]
The classification of Weerda combines the suggestions of various authors and provides an overview based on increasing levels of deformity and the necessary surgical intervention.[5]
In Grade I malformations, most structures of the normal auricle are present. Examples are prominent ears, macrotia, cryptotia, cleft ear, moderate cup ear deformities, earlobe deformities, and other minor auricular deformities. Dysplasia Grade II includes severe cup ear deformities and the mini ear (concha type microtia). Some of the ear structures are extant but, for complete reconstruction, additional skin and/or cartilage are needed. Dysplasia Grade III, none of the normal structures are present. This group includes uni- or bi-lateral rudimentary auricle and anotia. In particular, Grade III dysplasia is often associated with changes in the external auditory canal including aural atresia, malformations of the middle ear, and sometimes even dysplasia of the petrous bone with facial anomalies and the facial nerve being affected on the ipsilateral side. In such cases, additional skin and cartilage or other materials are required for total reconstruction.[6],[7],[8]
The current case falls under Grade I and was treated prosthetically.
Furthermore, a nonoperative rehabilitation for patients with acquired facial defect improves esthetics and quality of life; this treatment involves reintegration of the patient into the family and social life.
Acceptable esthetics in restoring a prominent facial defect like a malformed ear is a challenging task for a maxillofacial prosthodontist. Leading a life with this kind of a physical deformity is very stressful and often depressing for the patient. It directly affects the patient's mental, social, and psychological well-being.
Auricle is mainly made of fibrocartilage lined by skin except few parts like lobule, which consists of skin covering the connective tissue. An alternative to surgical reconstruction is the creation of a silicone auricular prosthesis. These prostheses provide a cost-effective and cosmetically acceptable means of camouflage for patients who decline or postpone surgical reconstruction. The use of remaining tissue of the rudimentary ear, combined with bio-adhesives provides a very conservative approach to fabricate a maxillofacial prosthesis. Placement of implant supported Hader bar and clip attachments have significantly improved the retention properties of the prosthesis. In cases where implants are not indicated or where the patient is not willing to undergo surgical procedures, the above-mentioned treatment procedures remain the best suited noninvasive treatment option as maxillofacial prosthesis with bioadhesive is a conservative approach with no surgical intervention.[9]
Fabricating unilateral prosthesis remains a more challenging task as compared to a bilateral auricular prosthesis, as this presents a constant comparison with a natural counterpart. The ideally constructed prosthesis must duplicate the missing facial features so precisely that, the casual observer notices nothing that would draw attention to the prosthetic reconstruction. Though it is a challenge, if certain minimal guidelines are followed, it would be of great help to the practitioners to provide a natural simulation of the opposing ear.
| Conclusion | | |
The maxillofacial prosthesis is an art, which can give life like an appearance and confidence to the patient. Education and motivation is the prime key for the acceptance of the prosthesis. Patient acceptance factors such as flexibility, translucency, esthetics, compatibility, durability, and prosthetic considerations such as availability of materials, ease of processing, ease of duplication lead to success of treatment making the prosthesis look life like and giving the patient social confidence.
| References | | |
| 1. | Khindria SK, Bansal S, Kansal M. Maxillofacial prosthetic materials. J Indian Prosthodont Soc 2009;9:2-5.   |
| 2. | Chalian VA, Phillips RW. Materials in maxillofacial prosthetics. J Biomed Mater Res 1974;8:349-63. |
| 3. | Mohammed K, Vaidyanathan A, Mani U, Bhatia Y, Veeravalli PT. Rehabilitation of an auricular defect using spectacle retained silicone ear prosthesis and ear stent. Int J Prosthodont Restorative Dent 2012;2:29-33. |
| 4. | Nanda A, Jain V, Kabra SK. Avenues for rehabilitation of auricular defects. Indian J Dent Res 2012;23:87-91. [ PUBMED] |
| 5. | Bartel-Friedrich S, Wulke C. Classification and diagnosis of ear malformations. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007;6:Doc05. |
| 6. | Nagata S. Modification of the stages in total reconstruction of the auricle: Part I. Grafting the three-dimensional costal cartilage framework for lobule-type microtia. Plast Reconstr Surg 1994;93:221-30. |
| 7. | Nagata S. Modification of the stages in total reconstruction of the auricle: Part II. Grafting the three-dimensional costal cartilage framework for concha-type microtia. Plast Reconstr Surg 1994;93:231-42. |
| 8. | Storck K, Staudenmaier R, Buchberger M, Strenger T, Kreutzer K, von Bomhard A, et al. Total reconstruction of the auricle: Our experiences on indications and recent techniques. Biomed Res Int 2014;2014:373286. |
| 9. | Singh A, Ghosh S, Kar S, Ahmed I. Silicone prosthesis for a patient with unilateral ear defect: A clinical case report. Eur J Gen Dent 2013;2:315-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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