Maxillofacial prosthetics and digital technologies: Cross-sectional study of healthcare service provision, patient attitudes, and opinions

PURPOSE

Digital technologies are continuously improving the accuracy and quality of maxillofacial prosthetics, but their impact on patients remains unclear. This cross-sectional study aimed to analyze the impact of facial prosthetics service provision, patients' perception, and digital technology on prostheses construction.

MATERIALS AND METHODS

All patients who presented for evaluation and management of facial defects between January 2021 and December 2021 at the ENT clinic were eligible for study enrollment. Patients requiring prosthetic reconstruction of their missing facial parts were included in the study. Forty-five questionnaires were delivered, inquiring about the patients' prosthetic demographics, prosthesis manufacture using 3D technologies, and their perceptions and attitudes.

RESULTS

A total of 37 patients responded (29 males, eight females; mean age 20.50 years). The congenital cause was the highest among other causes (p = 0.001) with auricular defects being the highest (p = 0.001). A total of 38 prostheses were constructed and 17 prostheses were retained by 36 craniofacial implants (p = 0.014). The auricular and orbital implants success rates were 97% and 25%, respectively. The implant locations were digitally planned pre-operatively. Digital 3D technologies of defect capture, data designing, and 3D modeling were used and perceived as helpful and comfortable (p = 0.001). Patients perceived their prosthesis as easy to handle, suited them, and they felt confident with it (p = 0.001). They wore it for more than 12 h daily (p = 0.001). They were not worried that it would be noticed, and found it comfortable and stable during various activities (p = 0.001). Implant-retained prosthesis patients were more satisfied with it, and found it easy to handle and stable (p = 0.001).

CONCLUSIONS

Congenital defects are the main cause of facial defects in the study country. The overall acceptance of maxillofacial prostheses was good, showing high patient perception and satisfaction. Ocular and implant-retained silicone prostheses are better handled, more stable, and the latter is more satisfying than traditional adhesive prostheses. Digital technologies save time and effort invested in manufacturing facial prostheses.

An ear-shaped film with a "leg"

Background

The reconstructed auricle projection is an essential element of ear reconstruction. The novel use of an ear-shaped film with one or two "legs" can successfully provide a healthy auricular contour, length, and width, hence improving the three-dimensional (3D) contour of the reconstructed auricle.

Methods

Sixty-one patients (31 men and 30 women) with unilateral ear reconstruction (22 on the left and 39 on the right side) who underwent auricular reconstruction using the novel ear-shaped film at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences between February 2021 and June 2022 were enrolled in this retrospective study.

Results

Using the Jarque-Bera and paired t-test, we found no statistically significant differences between the reconstructive and healthy ears in terms of length (5.93±0.56 vs. 5.89±0.49 cm, P=0.208), width (3.15±0.31 vs. 3.13±0.30 cm, P=0.224), height (2.48±0.33 vs. 2.51±0.36 cm, P=0.079), and perimeter (10.83±1.06 vs. 10.69±0.95 cm, P=0.164), using the novel ear-shaped film. The reconstructed auricle location was deemed satisfactory for all patients and their families.

Conclusions

The novel ear-shaped film may reflect the structure and height of the auricle during ear reconstruction surgery. Implementing this method is easy, and its impact is significant. This technique can be widely used in all types of otoplasties.

Metabolomic characterization of congenital microtia: a possible analysis for early diagnosis

Background

Although metabolic abnormalities have been deemed one of the essential risk factors for growth and development, the relationship between metabolic abnormalities and microtia is still unclear. In this study, we aimed to establish a cell model of microtia and the changes of serum metabolites in patients with microtia.

Methods

After constructing a cell model of microtia with low expression of BMP5, we performed integrative metabolomics analysis. For the altered metabolites, the content of glycerophosphocholine (PC), triacylglycerol (TG), and choline in the serum of 28 patients (15 patients with microtia and 13 controls) with microtia was verified by enzyme-linked immunosorbent assay (ELISA).

Results

Detailed metabolomic evaluation showed distinct clusters of metabolites between BMP5-low expressing cells and normal control (NC) cells. The cell model of microtia had significantly higher levels of TG, PC, glycerophosphoethanolamine (PE), sphingomyelin, sulfatide, glycerophosphoglycerol, diacylglycerol, and glycosphingolipid. The main abnormal metabolites were mainly concentrated in the glycerophospholipid metabolism pathway, and PC and choline were closely related. In the serum of patients with microtia, the contents of PC, TG, and choline were significantly increased.

Conclusions

The individual serum samples confirmed the different metabolites between patients with microtia and controls. In particular, we showed that a newly developed metabolic biomarker panel has a high sensitivity and specificity for separating patients with microtia from controls.

A novel method to accurately locate the reconstructed auricle

BACKGROUND

Congenital microtia is a common congenital disease in children, the cause of which is still unclear. At present, the main treatment for congenital microtia is ear reconstruction. Accurately locating of the reconstructed ear on the affected side before ear reconstruction surgery is difficult, while it is the key of successful operation. Our ear reconstruction team has developed a novel method to accurately locate the reconstructed auricle. This novel method has achieved good results in clinical practice.

METHODS

Thirty patients with unilateral ear reconstruction, who underwent auricle reconstruction using our invented auricle reconstruction positioning method in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2020 to July 2021, were enrolled in this study.

RESULTS

Through Wilcoxon signed rank test, we found that there was no statistical difference between the mean distance from the highest point of the patient's normal ear to the central axis of the nose and that from the highest point of the reconstructed ear to the central axis of the nose (P>0.05). Meanwhile, there was no statistical difference between the mean distance from the lowest point of the patient's normal ear to the central axis of the nose and that from the lowest point of the reconstructed ear to the central axis of the nose (P>0.05). The satisfaction rate of patients and their families to the location of the reconstructed auricle was 100%.

CONCLUSIONS

The novel method of locating the reconstructed auricle employs simple materials. The implementation process is easy, and the effect is significant. To a certain extent, it solves the difficulty of locating the reconstructed auricle in ear reconstruction operation. Although this method can only be applied to patients with unilateral microtia, we recommend it for locating the reconstructed auricle by every plastic surgeon.

[Clinical analysis of congenital microtia complicated with retroauricular subperiosteal abscess in 7 cases]

Objective:To dissect the etiology and clinical features of congenital microtia with retroauricular subperiosteal abscess, and to explore its pathogenesis and prognosis. Methods:Among 178 patients with congenital microtia, 7 cases concomitant with " retroauricular subperiosteal abscess" were collected in this retrospective study . All of the 7 patients underwent mastoidotomy, the lesions were cleared, and secretions were sent to the bacterial culture test. According to the middle ear lesions, we performedopen mastoidectomy + tympanoplasty in 3 cases， wall mastoidectomy + tympanoplasty in 3 cases of andradical mastoidectomy in 1 case.The wound healing was observed subsequently， and the patients were followed up 3 months later. Results:The patients were mainly young. The average of air-bone gap before operation was （57.14±9.51） dB. The average ofair-bone gap after operation was （40.00±11.54） dB, which was lower than that before （17.14±11.12） dB. The operation can effectively control the flow of pus and improve hearing. Postoperative ear abscess was effectively controlled, and there is no recurrence, after half a year of follow-up. Conclusion:Early diagnosis of mastoiditis is of great significance for congenital microtia complicated with retroauricular subperiosteal abscess. It should be diagnosed and intervened as soon as possible. Once it develops into abscess, tympanoplasty should be performed as soon as possible, for cleaning lesions and draining obstruction, subsequently as to provide favorable conditions for the repair of auricular malformation.

Craniofacial microsomia: Reflections on diagnosis and severity assessment based on a series of cases

This study aims to discuss diagnostic criteria and severity assessment for craniofacial microsomia (CFM). A series of 61 patients with diverse CFM phenotypes had their clinical data collected by experienced dysmorphologists using a single protocol. Genetic abnormalities were searched through karyotype and chromosomal microarray analysis. Sex ratio, prenatal risk factors, and recurrence rate corroborated the literature. Despite the wide variability of clinical findings, ear disruption was universal. Eight patients were assigned as syndromic, four of whom had demonstrable genetic alterations. The majority of patients (67.2%) fulfilled four known diagnostic criteria, while 9.8% fulfilled one of them. Data strengthened disruptions of the ear and deafness as a semiotically valuable sign in CFM. Facial impairment should consider asymmetry as a mild expression of microsomia. Spinal and cardiac anomalies, microcephaly, and developmental delay were prevalent among extra craniofacial features and should be screened before planning treatment and follow up. The severity index was able to recognize the less and the most affected patients. However, it was not useful to support therapeutic decisions and prognosis in the clinical scenario due to syndromic and non-syndromic phenotypes overlapping. These issues make contemporary the debate on diagnostic methods and disease severity assessment for CFM. They also impact care and etiopathogenetic studies.

3D Printing of a BAHA Protective Cap

Mechanical feedback is one of the most common difficulties encountered when fitting hearing aids for toddlers and young children. We described the use of 3D printing to tailor a protective cap for a toddler with bilateral microtia/canal atresia to facilitate bone-anchoring hearing aid use.

[Retroauricular teratoma with congenital microtia and ankylotia: a case report]

Teratoma is a germ cell tumor, which is rare behind the ear. We described a rare case of retroauricular teratoma accompanied with congenital malformation of external and middle ear and cholesteatoma of middle ear in a 13-years-old girl. Congenital microtia and ankylotia of right ear was found since childhood, suppuration occurred repeatedly behind the right ear 1 year ago. Temporal bone CT and MRI scan revealed congenital malformation of middle ear and cholesteatoma of middle ear. Cystic mass containing a tooth was found intraoperatively. The pathological results showed that it was benign cystic teratoma. It showed no evidence of recurrence on the patient during 3 months follow-up.

Validity and reliability of three-dimensional costal cartilage imaging for donor-site assessment and clinical application in microtia reconstruction patients: A prospective study of 22 cases

OBJECTIVES

This study assesses the ability to reconstruct costal cartilage images by using three-dimensional visualisation software (Mimics) based on semi-automated segmentation algorithm and to investigate its reliability and validity with an anthropometric analysis.

DESIGN

Observational prospective study.

SETTING

Plastic surgery department of a tertiary hospital.

PARTICIPANTS

Twenty-two microtia patients who underwent autologous ear reconstruction.

MAIN OUTCOME MEASURES

Preoperative thoracic computed tomography data were processed to Mimics software for three-dimensional costal cartilage imaging. The length, width, thickness and volume of the 9th costal cartilages were calculated from these images and compared with the direct measurements (DM) obtained intraoperatively.

RESULTS

The intra-examiner reliability and inter-examiner reliability were high in terms of all four measurements (intraclass correlation coefficients, ICC: 0.876-0.984). There were no significant differences between image-based anthropometry and DM in the linear measurements except for the volume (P < .05). The mean volume calculation error of Mimics was -0.08 ± 0.13 mL. No correlation was found between the anthropometric variables and the absolute errors (P > .05). Furthermore, Bland-Altman plots were used to evaluate the agreement between the two methods.

CONCLUSIONS

Despite a very small error was found in volume calculation, Mimics software was accurate and reliable in linear calculation. Three-dimensional costal cartilage imaging was found to be an efficient tool for morphological evaluation of costal cartilages. We believe that with the application of individualised cartilage models based on three-dimensional printing, the use of customised ear framework carving will be practicable in surgical training.

Auricular reconstruction

External ear abnormalities are common. These may affect ear shape, size, prominence and degree of development. They may also be associated with hearing loss. The early identification and management of hearing loss is essential. There are several options for reconstruction of the external ear using both autologous and non-autologous techniques. The aim of this article is to outline the different reconstructive options.

Effect of availability of video laryngoscopy on the use of fiberoptic intubation in school-aged children with microtia

BACKGROUND

With the increasing popularity of video laryngoscopy during intubation of pediatric patients with normal or difficult airways, fiberoptic-assisted tracheal intubation, traditionally considered the gold standard for difficult intubation, may become underused.

AIM

We aimed to assess the use of airway management techniques before and after introduction of video laryngoscopy in a cohort of school-aged children with microtia, who are at increased risk of difficult intubation.

METHODS

We retrospectively reviewed intubation devices used for all pediatric patients with microtia who had undergone reconstructive ear surgery at a single institution during the period January 2008 to December 2012. In each case, we identified the original airway management technique and success rate, as well as success rate for subsequent rescue techniques. The use of fiberoptic-assisted tracheal intubation was compared before and after introduction of a pediatric blade for the Pentax-AWS video laryngoscope.

RESULTS

This study included 537 consecutive intubation procedures; 264 before and 273 after introduction of the pediatric airway scope. Elective use of fiberoptic-assisted tracheal intubation for anticipated difficult intubation was significantly less after introduction of the pediatric airway scope (before: 19 of 79, 24% vs after: 3 of 79, 4%; odds ratio 8.02; 95% confidence interval, 2.27 to 28.39; P = .0003), which achieved a 100% success rate when used as the primary technique in both routine and difficult airways. All 5 cases of failed direct laryngoscopy were rescued by the pediatric airway scope, thus eliminating emergency use of fiberscopy.

CONCLUSION

Introduction of a pediatric video laryngoscope resulted in a substantial decrease in the use of fiberoptic-assisted tracheal intubation. This change in intubation method might not influence the success rate of intubation in experienced hands but could be relevant for novice users.

Middle ear abnormalities in Van Maldergem syndrome

Van Maldergem syndrome (VMS) is a very rare syndrome that was first described in 1992. The main features of this syndrome comprise intellectual disability, blepharo-naso-facial malformation, and hand anomalies. Almost all nine described patients have been shown to be affected by conductive hearing impairment attributed to microtia, and atresia of the outer ear canal. Here, we present a VMS patient with congenital malformations of the middle ear as the main reason for severe conductive bilateral hearing impairment. To our knowledge, this is the first report to describe middle ear abnormalities in VMS. These malformations were seen on high resolution Computed Tomography scanning and during an exploratory tympanotomy. Due to the severity of the middle ear abnormalities and the risk for facial nerve damage, the patient was not offered an ossicular chain reconstruction but a bone conduction device after this exploratory tympanotomy. © 2016 Wiley Periodicals, Inc.