Aesthetic reconstruction of microtia: a review of current techniques and new 3D printing approaches

ABSTRACT Three dimensional (3D) printing and biofabrication technologies are revolutionising medicine with low-cost and novel treatments for complex medical conditions. These approaches differ from traditional treatments by using 3D scanning, computer modelling and 3D printing to automate the production of patient-specific tissue replacement or prostheses using a wide range of materials. One area impacted by this technology is the treatment of congenital maxillofacial conditions such as microtia, a condition affecting the intrauterine development of the auricle (external ear) and with a prevalence of 2.06 cases for every 10,000 births. While not life-threatening, microtia significantly impacts the emotional and psychological well-being of the affected child and their parents. Current treatments include the use of prosthetic ears or surgical methods such as autografting rib cartilage or alloplastic implants. Although current options have shown documented success, they are highly dependent on the surgeon’s skill and it has been demonstrated that poor quality solutions can further exacerbate negative psychosocial impacts. As such, higher quality, lower cost and more customised options would be welcomed by patients and parents alike. Recent advances in 3D scanning, modelling and printing techniques could significantly benefit the treatment and reconstructive options for children with microtia, leading to improved quality of life.

[1]  Hermann Marx,et al.  Die Mißbildungen des Ohres , 1926 .

[2]  R. C. Tanzer TOTAL RECONSTRUCTION OF THE EXTERNAL EAR , 1959, Plastic and reconstructive surgery and the transplantation bulletin.

[3]  E. Castilla,et al.  Prevalence rates of microtia in South America. , 1986, International journal of epidemiology.

[4]  S. Nagata Modification of the Stages in Total Reconstruction of the Auricle: Part II. Grafting the Three‐Dimensional Costal Cartilage Framework for Concha‐Type Microtia , 1994, Plastic and reconstructive surgery.

[5]  S. Nagata Modification of the Stages in Total Reconstruction of the Auricle: Part I. Grafting the Three‐Dimensional Costal Cartilage Framework for Lobule‐Type Microtia , 1994, Plastic and reconstructive surgery.

[6]  B. Brent,et al.  Modification of the Stages in Total Reconstruction of the Auricle, Parts I to IV , 1994 .

[7]  S. Nagata,et al.  Modification of the Stages in Total Reconstruction of the Auricle: Part III. Grafting the Three‐Dimensional Costal Cartilage Framework for Small Concha‐Type Microtia , 1994, Plastic and reconstructive surgery.

[8]  Charles A. Vacanti,et al.  Transplantation of Chondrocytes Utilizing a Polymer‐Cell Construct to Produce Tissue‐Engineered Cartilage in the Shape of a Human Ear , 1997, Plastic and reconstructive surgery.

[9]  B Brent,et al.  Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experience with 1200 cases. , 1999, Plastic and reconstructive surgery.

[10]  K. Penkner,et al.  Fabricating auricular prostheses using three-dimensional soft tissue models. , 1999, The Journal of prosthetic dentistry.

[11]  R. Rapini,et al.  Silicone auricular prosthesis. , 2000, Journal of the American Academy of Dermatology.

[12]  J. Vacanti,et al.  Tissue engineering auricular reconstruction: in vitro and in vivo studies. , 2004, Biomaterials.

[13]  Esther Vögelin,et al.  Psychosocial Outcome of Patients After Ear Reconstruction: A Retrospective Study of 62 Patients , 2005, Annals of plastic surgery.

[14]  F. Carinci,et al.  Clinical Outcome of 285 Medpor Grafts used for Craniofacial Reconstruction , 2005, The Journal of craniofacial surgery.

[15]  R. D. Merz,et al.  Descriptive epidemiology of anotia and microtia, Hawaii, 1986–2002 , 2005, Congenital anomalies.

[16]  M. Yaremchuk,et al.  Tissue-Engineered Flexible Ear-Shaped Cartilage , 2005, Plastic and reconstructive surgery.

[17]  T. Tollefson Advances in the treatment of microtia , 2006, Current opinion in otolaryngology & head and neck surgery.

[18]  Gianfranco Gassino,et al.  CAD/CAM ear model and virtual construction of the mold. , 2007, The Journal of prosthetic dentistry.

[19]  Kimitaka Kaga,et al.  Hearing Levels in Patients With Microtia: Correlation With Temporal Bone Malformation , 2007, The Laryngoscope.

[20]  A. Ritvanen,et al.  Microtia in Finland: comparison of characteristics in different populations. , 2007, International journal of pediatric otorhinolaryngology.

[21]  Karupppasamy Subburaj,et al.  Rapid development of auricular prosthesis using CAD and rapid prototyping technologies. , 2007, International journal of oral and maxillofacial surgery.

[22]  Chai Jia-ke,et al.  An investigation of psychological profiles and risk factors in congenital microtia patients. , 2008, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[23]  I. König,et al.  The psychosocial consequences of reconstruction of severe ear defects or third-degree microtia with rib cartilage. , 2008, Aesthetic surgery journal.

[24]  S. D. Reitzen,et al.  Aesthetic microtia reconstruction with Medpor. , 2008, Facial plastic surgery : FPS.

[25]  Tianrui Zhou,et al.  Fused deposition modelling of an auricle framework for microtia reconstruction based on CT images , 2008 .

[26]  C. Richter,et al.  The importance of auricular prostheses for speech recognition. , 2008, Archives of facial plastic surgery.

[27]  Y. Ikada,et al.  Tissue engineering a model for the human ear: Assessment of size, shape, morphology, and gene expression following seeding of different chondrocytes , 2009, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[28]  J. Sidman,et al.  Complications and satisfaction with pediatric osseointegrated external ear prostheses , 2009, The Laryngoscope.

[29]  Peter H Langlois,et al.  Epidemiologic features and clinical subgroups of anotia/microtia in Texas. , 2009, Birth defects research. Part A, Clinical and molecular teratology.

[30]  D. Gault,et al.  Patient satisfaction and aesthetic outcomes after ear reconstruction with a Branemark-type, bone-anchored, ear prosthesis: a 16 year review. , 2010, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[31]  Feng Xu,et al.  Psychosocial Outcomes Among Microtia Patients of Different Ages and Genders Before Ear Reconstruction , 2010, Aesthetic Plastic Surgery.

[32]  Federica Chiellini,et al.  Polymeric Materials for Bone and Cartilage Repair , 2010 .

[33]  A. Czeizel,et al.  Prevalence at birth of congenital abnormalities of external ears in Hungary , 2011 .

[34]  Dietmar W Hutmacher,et al.  Direct Writing By Way of Melt Electrospinning , 2011, Advanced materials.

[35]  Pierpaolo Mastroiacovo,et al.  Microtia-anotia: a global review of prevalence rates. , 2011, Birth defects research. Part A, Clinical and molecular teratology.

[36]  Peter Liacouras,et al.  Designing and manufacturing an auricular prosthesis using computed tomography, 3-dimensional photographic imaging, and additive manufacturing: a clinical report. , 2011, The Journal of prosthetic dentistry.

[37]  W. Sabbagh Early experience in microtia reconstruction: the first 100 cases. , 2011, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[38]  Alexander M. Seifalian,et al.  Tissue Engineering: Revolution and Challenge in Auricular Cartilage Reconstruction , 2012, Plastic and reconstructive surgery.

[39]  D. Staffenberg,et al.  Current Management of Microtia: A National Survey , 2013, Aesthetic Plastic Surgery.

[40]  K. Fung,et al.  The versatility of the temporoparietal fascia flap in head and neck reconstruction. , 2012, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[41]  Lu Ji,et al.  Evaluation of direct and indirect additive manufacture of maxillofacial prostheses , 2012, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[42]  A. Selçuk,et al.  Microtia and Congenital Aural Atresia , 2012, The Journal of craniofacial surgery.

[43]  Stefan Maierhofer,et al.  Evaluation of Methods for Optical 3-D Scanning of Human Pinnas , 2013, 2013 International Conference on 3D Vision.

[44]  Interrater reliability of a phenotypic assessment tool for the ear morphology in microtia , 2013, American journal of medical genetics. Part A.

[45]  Dietmar W Hutmacher,et al.  Electrospinning and additive manufacturing: converging technologies. , 2013, Biomaterials science.

[46]  Guangdong Zhou,et al.  Engineering ear-shaped cartilage using electrospun fibrous membranes of gelatin/polycaprolactone. , 2013, Biomaterials.

[47]  Jason A. Spector,et al.  High-Fidelity Tissue Engineering of Patient-Specific Auricles for Reconstruction of Pediatric Microtia and Other Auricular Deformities , 2013, PloS one.

[48]  J. Malda,et al.  Biofabrication of multi-material anatomically shaped tissue constructs , 2013, Biofabrication.

[49]  Michael C. McAlpine,et al.  3D Printed Bionic Ears , 2013, Nano letters.

[50]  Ruth A Aponte-Wesson,et al.  Autogenous and prosthetic reconstruction of the ear. , 2013, Oral and maxillofacial surgery clinics of North America.

[51]  Yong He,et al.  Fabrication of low cost soft tissue prostheses with the desktop 3D printer , 2014, Scientific Reports.

[52]  C. Park,et al.  Auricular reconstruction: A review of available methods , 2014 .

[53]  Moshe Kon,et al.  Microtia in the Netherlands: clinical characteristics and associated anomalies. , 2014, International journal of pediatric otorhinolaryngology.

[54]  Anthony P Sclafani,et al.  Microtia reconstruction: autologous rib and alloplast techniques. , 2014, Facial plastic surgery clinics of North America.

[55]  Jason Watson,et al.  Complete integration of technology for improved reproduction of auricular prostheses. , 2014, The Journal of prosthetic dentistry.

[56]  S. Lew,et al.  Subdural hematoma--a rare complication of removal of osseointegrated auricular prosthesis retention system. , 2014, International journal of pediatric otorhinolaryngology.

[57]  Lim Kwong Cheung,et al.  Psychosocial and Quality of Life Outcomes of Prosthetic Auricular Rehabilitation with CAD/CAM Technology , 2014, International journal of dentistry.

[58]  K. Kreutzer,et al.  Total Reconstruction of the Auricle: Our Experiences on Indications and Recent Techniques , 2014, BioMed research international.

[59]  Narges Baluch,et al.  Auricular reconstruction for microtia: A review of available methods. , 2014, Plastic surgery.

[60]  Nathan Andrew Kludt,et al.  Auricular Reconstruction With Prolonged Tissue Expansion and Porous Polyethylene Implants , 2014, Annals of plastic surgery.

[61]  Peidong Dai,et al.  A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction , 2015, ORL.

[62]  P. V. van Zuijlen,et al.  Developing a parametric ear model for auricular reconstruction: a new step towards patient-specific implants. , 2015, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[63]  Jos Malda,et al.  Reinforcement of hydrogels using three-dimensionally printed microfibres , 2015, Nature Communications.

[64]  D. Im,et al.  Pre and post-operative psychological functioning in younger and older children with microtia. , 2015, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[65]  Dietmar W. Hutmacher,et al.  Enhancing structural integrity of hydrogels by using highly organised melt electrospun fibre constructs , 2015 .

[66]  M Kon,et al.  Auricular reconstruction using biofabrication-based tissue engineering strategies , 2015, Biofabrication.

[67]  Ope Asanbe,et al.  Long-Term Morphological and Microarchitectural Stability of Tissue-Engineered, Patient-Specific Auricles In Vivo. , 2016, Tissue engineering. Part A.

[68]  David A Zopf,et al.  Computer-Aided Design and 3D Printing to Produce a Costal Cartilage Model for Simulation of Auricular Reconstruction , 2016, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[69]  D. Saini,et al.  Implant-retained auricular prostheses: a clinical challenge. , 2016, International journal of oral and maxillofacial surgery.

[70]  Martyn Sherriff,et al.  Development of a 3D printable maxillofacial silicone: Part I. Optimization of polydimethylsiloxane chains and cross-linker concentration. , 2016, The Journal of prosthetic dentistry.

[71]  K. Kaga,et al.  Sound lateralization test in patients with unilateral microtia and atresia after reconstruction of the auricle and external canal and fitting of canal-type hearing aids , 2016, Acta oto-laryngologica.

[72]  S. Ferguson,et al.  Direct electrospinning of 3D auricle-shaped scaffolds for tissue engineering applications , 2016, Biofabrication.

[73]  Jorge Vicente Lopes da Silva,et al.  Monoscopic photogrammetry to obtain 3D models by a mobile device: a method for making facial prostheses , 2016, Journal of Otolaryngology - Head & Neck Surgery.

[74]  James J. Yoo,et al.  A 3D bioprinting system to produce human-scale tissue constructs with structural integrity , 2016, Nature Biotechnology.

[75]  L. P. Tan,et al.  Electrospun 3D multi-scale fibrous scaffold for enhanced human dermal fibroblast infiltration , 2016 .

[76]  Dong-Woo Cho,et al.  Computer-aided multiple-head 3D printing system for printing of heterogeneous organ/tissue constructs , 2016, Scientific Reports.

[77]  Sanjairaj Vijayavenkataraman,et al.  Investigation of process parameters of electrohydro-dynamic jetting for 3D printed PCL fibrous scaffolds with complex geometries , 2016 .

[78]  Sean K. Powell,et al.  Biofabrication: The Future of Regenerative Medicine , 2016 .

[79]  May Win Naing,et al.  Skin Bioprinting: Impending Reality or Fantasy? , 2016, Trends in biotechnology.

[80]  J. Vacanti,et al.  Chondrogenesis by bone marrow‐derived mesenchymal stem cells grown in chondrocyte‐conditioned medium for auricular reconstruction , 2017, Journal of tissue engineering and regenerative medicine.

[81]  Dong-Woo Cho,et al.  Development of a 3D cell printed structure as an alternative to autologs cartilage for auricular reconstruction. , 2017, Journal of biomedical materials research. Part B, Applied biomaterials.

[82]  J. Lighthall,et al.  Prosthetic reconstruction of the ear , 2017 .

[83]  Nathan J. Castro,et al.  Enhanced bone tissue regeneration using a 3D printed microstructure incorporated with a hybrid nano hydrogel. , 2017, Nanoscale.

[84]  D. Im,et al.  Teasing in younger and older children with microtia before and after ear reconstruction , 2017, Journal of plastic surgery and hand surgery.

[85]  Ian Gibson,et al.  Advanced auricular prosthesis development by 3D modelling and multi-material printing , 2017 .

[86]  Martyn Sherriff,et al.  Development of a 3D printable maxillofacial silicone: Part II. Optimization of moderator and thixotropic agent , 2017, The Journal of prosthetic dentistry.