Lobule separator prosthesis to prevent adhesion of reconstructed ear lobe.

An adhesion is a band of scar tissue that binds two parts of the tissue together, which develops when the body's repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation. Prevention of unwanted scar bands is of utmost importance to develop esthetic and healthy tissue. This article describes a technique to prevent the adhesion of the surgically reconstructed ear lobule with facial skin, using novel lobule separator prosthesis.

INTRODUCTION

Following surgical repair, adhesions typically begin to form within the 1st few days. These adhesions may not produce symptoms for months or even years but may generate unesthetic and undesirable tissue bands, which are not acceptable. Achieving an esthetically pleasing result has always been demanding.[1] Partial reconstruction of ear lobule started way back in 900 BC by Susruta, an Indian text of ancient medicine.[2] It has been suggested by Kumar and Shah[3] that the reconstruction of congenitally deficient ear lobule is easier than reconstruction of the traumatized ear lobule due to burns. However, complications, such as adhesion of the surgical site can occur which are very annoying to the patient as well as to the surgeons. In the present technique, the novel lobule separator prosthesis was fabricated to support and to prevent the adhesion of reconstructed ear lobule with facial skin.

CASE REPORT

A 13-year-old female patient was referred to the Department of Prosthodontics, from the Department of Otolaryngology, for the prevention of skin adhesion between the reconstructed ear lobule and facial skin under the lobule. On examination, the reconstructed ear lobule was adhered to the facial skin [Figure 1]. It was reported by the otolaryngologist that the adhesion had occurred twice, each time after a surgery. In treatment planning, it was decided to fabricate a prosthesis, which will prevent the adhesion between reconstructed ear lobule and the underlying facial skin.

Figure 1

Preoperative view of the ear lobule adhesion

PROSTHESIS FABRICATION

The armamentarium to fabricate the prosthesis includes, 0.9 mm stainless steel wire, rubber tubing, stethoscope ear piece, putty elastomeric material, heat polymerized acrylic resin, and modelling wax. The patient preparation for impression was done by covering the external auditory meatus with gauze, to prevent the ingress of material into the ear canal. The defect was outlined and an impression of the defect was made with irreversible hydrocolloid (Dentsply Zelgan Plus irreversible hydrocolloid, India). L-shaped paper clips were inserted for stabilization of Plaster of Paris, which was used for the reinforcement of the impression material. Once the impression material was set, it was removed carefully and poured with dental stone (Kalstone, laboratory stone, Kalabhai, Mumbai, India), to obtain a master cast of the defect [Figure 2]. On the working cast, a 0.9 mm stainless steel wire (Dentaurum SS wire Germany) was adapted from external auditory meatus, passing around the pinna, to the reconstructed ear lobule. A stethoscope ear piece (Pulse-Wave Stethoscopes, NISCO, Delhi, India) was attached to the adapted wire with the help of putty elastomeric material (Reprosil vinyl polysiloxane impression material, Dentsply, Bangalore, India). This will help to retain the prosthesis from external auditory meatus. The stainless steel wire was covered with the rubber tubing to prevent any trauma or irritation to the postauricular skin. On the other end of the wire, pattern of the prosthesis was fabricated with modelling wax and molded according to the shape of the reconstructed lobule. The wax pattern was contoured in a “U” shaped notch, so that it could fit to the undersurface of the reconstructed lobule. A bulge had been given posteriorly to support the reconstructed lobule. The wax pattern was tried and verified by the otolaryngologist as per their requirements. The prosthesis was processed conventionally, finished, and polished [Figure 3]. At the time of surgical separation of the reconstructed lobule and the skin, the prosthesis was positioned [Figures 4 and 5]. Minor adjustment was done for the adaptation of the prosthesis. The patient was instructed to clean the surgical area and prosthesis regularly for the prevention of infection. Surgical site was evaluated after 6 weeks, the lobule separation was achieved successfully [Figure 6].

Figure 2

Master cast

Figure 3

Ear lobule separator prosthesis

Figure 4

Surgical separation

Figure 5

Placement of prosthesis after surgical separation

Figure 6

Postoperative view of the reconstructed ear lobule

DISCUSSION

A long-term and unpredictable problem, postoperative adhesions increases the surgical overload and undesirable health care expenditures. The two major strategies for adhesion prevention or reduction are adjusting surgical technique and applying adjuvants. Adjuvants fall into two main categories, drugs and barriers.[45] The present technique shows a mechanical barrier in the form of lobule separator. The advantages of the prosthesis are that it is very economical, easy, and simple to construct. This prefabricated prosthesis can save valuable time in the operating room, and better cosmetic results can be achieved as the prosthesis was checked against a master cast and the adjustments are made before the patient undergoes surgery. Mechanical separation could have been achieved by applying surgical dressing on the skin opposing reconstructed site; however, the advantages of using spacer over the simple surgical dressings are it provides space between two raw areas which was there in this case.

Second, it was precautionary effort to avoid adhesion and excess scarring. Being a child, revision procedure due to repeat anesthesia would be difficult so a spacer was planned to “keep” away the cleft/division from the face and the ear lobule. It also helped to further reduce the cleft dimension than expected. The additive advantage of presented spacer is that it also acts as a pressure effect to avoid scar hypertrophy.

CONCLUSION

A novel ear lobule separator prosthesis is reported in this article. The procedure of fabrication is easy and simple. It is a forthright technique to resolve the problem of skin adhesion between the reconstructed ear lobule and underlying facial skin. The present technique showed good cosmetic results after reconstruction of an absent ear lobe. This is the first report of its use and the result was good.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.