Repair of
congenital defects of the ear remains one of the challenging issues in plastic
and reconstructive surgery due to its highly complex topology and its
importance aesthetically as well as functionally. Microtia, meaning ‘small
ear’, is one of the most common types of congenital ear defect. Children with
microtia have an underdeveloped external ear also known as the pinna and the
total absence of the latter is called anotia. The other common ear defect is a prominent
ear, which is an abnormally protruding ear. Both anomalies usually result from
the malformation of cartilage during primitive ear development in intrauterine
life.

Otoplasty has
undergone important developments in recent times, with numerous techniques
being presented in the surgical literature. This review presents updated
information on the types of reconstructions; using autogenous costal cartilage,
alloplastic materials, prosthesis and the novel concept of 3D printing; its
issues and why this technology is not ready yet.

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Autogenous
costal cartilage is still considered as an ideal material for making the framework
in microtia reconstruction. Many surgeons have adopted the Nagata approach, the
Brent approach, or variations of the two, in their work. With these employed
techniques, auricles reconstructed by experienced surgeons have proven to be
aesthetically promising. However, concerning the harvesting of the costal
cartilage, the underdevelopment of the site of the donor’s chest wall, alopecia
of the scalp, and scarring of the posterior auricular-mastoid areas are still
considered problematic facets of these techniques. Some articles have described
attempts to solve those problems, whereas some experiments in cartilage
production using tissue engineering techniques have shown promise in their
initial stages of development.

In recent years,
3D printing in the field of biomedical engineering has made its applications
limitless, with the production of ‘bionic ears’ which could potentially
revolutionise ear reconstruction but the outcomes of those ongoing experiments
and their implementations are yet to be seen.

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