Implants for reconstructive surgery of the nose and ears

Abstract

Implants shorten reconstruction, reduce trauma for the patients, are, in principle, of unlimited availability and can be given definable qualities that outnumber those of biological transplants. Lots of sometimes exotic materials have already been suggested for facial surgery and most of them have turned out to be unsuitable in the short or long term, because they did not satisfactorily fulfil the requirements of a "perfect implant". However, transplants obviously cannot be regarded as ideal either because they often involve the necessity of a second intervention for removal, they are only available to a limited extent and some are at risk of postoperative deflection, shrinkage and absorption. This article is concerned with current knowledge about implant materials for rhinoplasty and ear reconstruction. Autogenous transplants will also be briefly discussed. The repetition of known facts should be largely avoided. In relation to this reference will be made to earlier papers [1].

Table 1. Properties of implant materials

Figure 1. Implant made from PE for correction of saddle nose defect. Nose bridge strut and septum replacement were fused using point heating with an electrocautery.

a: Side view b: Frontal; demonstration of flexibility of septum replacement

Figure 2. Number of individual revision rhinoplasties and complications (n=32)

Figure 3. Correction of a saddle nose with an implant as in Fig. 1, via endonasal access

a: Preoperative b: Postoperative

Figure 4. Two-part ear skeleton made from PE (Porex Surgical, Newnan, GA, USA)

Figure 5. Ear reconstruction with PE skeleton and parietotemporal fascia flap

a: Marking of hairline, incision, position of planned ear, position of Temp. superficial artery b: Parietotemporal fascia flap with artery contained in it c: The flap over the ear region from below d: The PTF flap encase the PE skeleton e: Result after full-thickness skin covering f: Demonstration of postauricular sulcus

Figure 6. Ear reconstruction with PE skeleton and parietotemporal fascia flap (example 1)

a: Preoperative b: Postoperative

Figure 7. Ear reconstruction with PE skeleton and parietotemporal fascia flap (example 2)

a: Preoperative b: Postoperative

Figure 8. Ear reconstruction with PE skeleton and parietotemporal fascia flap (example 3)

a: Preoperative b: Postoperative

Figure 9. Ear reconstruction with PE skeleton and parietotemporal fascia flap following traumatic partial loss of ear; state following unsuccessful attempt at reconstruction of ear with costal cartilage that was almost completely absorbed (example 4)

a: Preoperative b: Postoperative