Osseointegrated alloplastic ear reconstruction with the implant-carrying plate system in children

Abstract

Osseointegration biotechnology has revolutionized ear prosthetic retention, and the benefits of osseointegrated alloplastic ear reconstruction have been well documented. The aim of this study is to present the authors' clinical experience with the implant-carrying plate system (EPITEC System) in children. For 3.5 years, 14 microtia patients (13 boys and one girl, ages 6 to 16 years) were treated with osseointegrated prosthetic ear reconstruction. A total of 30 titanium implant posts of the system were used; one of the patients had bilateral defects. Implant posts were inserted into a three-dimensional carrier plate, which was fixed by means of screws to the mastoid. All patients were operated on using a one-stage procedure allowing 2 to 3 months for osseointegration, followed by fabrication of the ear prostheses. After follow-up, which varied from 6 to 42 months for each patient, all implants that could be monitored were found to be stable. A total of 21 implant posts remained free from potentially dangerous skin reactions. The soft tissues around five of the implant posts in three patients were hypertrophied. One patient was lost to follow-up. The results suggest that the implant-carrying plate system offers several advantages in children: (1) Location of the implants is independent of the recipient bone available; (2) no apparent submergence is evident; (3) additional anchoring is achieved by newly formed bone growing over and covering the connecting bars of the three-dimensional carrier plate, which is only 1 mm thick; and (4) osseointegration is highly successful. Because of the limited number of cases represented in this article, along with a rather limited observation period, this study is preliminary. For a final evaluation, a longer observation time is needed. Despite this, the authors believe that a one-stage procedure with the system in the mastoid process in children can be recommended.