A Contemporary Review of Trachea, Nose, and Ear Cartilage Bioengineering and Additive Manufacturing

Abstract

The complex structure, chemical composition, and biomechanical properties of craniofacial cartilaginous structures make them challenging to reconstruct. Autologous grafts have limited tissue availability and can cause significant donor-site morbidity, homologous grafts often require immunosuppression, and alloplastic grafts may have high rates of infection or displacement. Furthermore, all these grafting techniques require a high level of surgical skill to ensure that the reconstruction matches the original structure. Current research indicates that additive manufacturing shows promise in overcoming these limitations. Autologous stem cells have been developed into cartilage when exposed to the appropriate growth factors and culture conditions, such as mechanical stress and oxygen deprivation. Additive manufacturing allows for increased precision when engineering scaffolds for stem cell cultures. Fine control over the porosity and structure of a material ensures adequate cell adhesion and fit between the graft and the defect. Several recent tissue engineering studies have focused on the trachea, nose, and ear, as these structures are often damaged by congenital conditions, trauma, and malignancy. This article reviews the limitations of current reconstructive techniques and the new developments in additive manufacturing for tracheal, nasal, and auricular cartilages.

Keywords: additive manufacturing; bioengineering; cartilage; ear; nose; reconstruction; septum; trachea.

Figure 1

(A): Endoscopic bronchoscopy view of a patient with post-intubation tracheal stenosis. (B): Endoscopic view after rigid bronchoscopic dilation and silicone stenting. Reprinted under Creative Commons License from ref. [31]. 2022, Creative Commons.

Figure 2

The external framework of the trachea, composed of C-shaped cartilaginous rings separated by an intercartilaginous membrane.

Figure 3

Anatomic photo of nasal septal quadrangular cartilage demonstrating key anatomic points and relationship of dorsal and caudal L-strut to key points.

Figure 4

Cross-sectional diagram of the mean, −1 SD, and +1 SD amounts of cartilage required for the reconstruction of the dorsal and caudal septal L-strut.

Figure 5

Staged reconstruction of auricular defect using costal cartilage. (a): Costal cartilage framework. (b): Cartilage framework tunneled subcutaneously and inset. Skin is contoured over the framework. (c): Postoperative result after first stage. Reprinted under Creative Commons License from ref. [74]. 2015, Creative Commons.