When skin cancer involves a large portion of the auricle, surgical treatment options include either Mohs excision or subtotal or total resection of the auricle. Each surgical approach has its unique advantages. Prosthetic reconstruction of the auricle offers the aesthetic rehabilitation option that can change the surgical treatment approach to skin cancer of the auricle.
Traditionally, these prostheses have been affixed to the face using special adhesives. Now, osseointegrated implants can offer a very stable and attractive solution allowing for an active life style. In addition, todayʼs silicone materials allow a facial prosthesis to appear so life-like that it is difficult to tell it apart from the rest of the face even on close inspection.
The osseointegrated fixtures use the Branemark System of titanium implants. These implants bond with the bone in a process known as osseointegration, providing a stable means of attaching a facial prosthesis without any glues or adhesives.
The titanium implant is inserted into predrilled holes in the bone under low torque to preserve the osteocytes for osseointegration.
During the same surgical session, abutments can be placed onto the osseointegrated screws that support the bars, clips, or magnets. Those in turn support the prosthesis. Although, this can be done as a single stage surgical procedure, in some clinical cases a two stage procedure is indicated. In those cases, osseointegrated screw implants are placed without percutaneous projection and are allowed to heal for 3 months before a force-bearing abutment is attached to them. The two stage technique is well-suited for patients with poor bone quality or irradiated bone.
The procedure is easily performed under local or sedation anesthesia. Most of the work of creating the prosthetic rehabilitation is performed by a prosthodontist or an anaplastologist in a laboratory. There, meticulous creation of the prosthetic ear takes place with mold sculpting and perfect color match with silicone painting.
Patient is required to maintain cleanliness of the percutaneous abutments with daily care. Complications are limited to loosening or infection of the screws that failed to osseointegrate. This procedure offers a low-risk alternative to patients unable or unwilling to undergo a complex surgical reconstruction of a subtotal auricle defect. The patients are able to engage in active lifestyle without prosthesis accidentally detaching.