The caudal margin of the pinna exhibits a cutaneous pouch called the marginal pouch (Figure 1-3). The leaf-shaped pinna of the external ear is broad with medial (rostral) and lateral (caudal) margins. The ear is moved by three sets of muscles (rostral, ventral, and caudal) that are innervated by branches of the facial nerve (cranial nerve VII). It is designed to localize and collect sound waves and transmit them to the tympanic membrane (eardrum). Carriage of the pinna is breed-specific in the dog but mostly upright in the cat. In some instances the patient will be able to wear the same prosthesis for years with only occasional refurbishing before a new molding is necessary.The pinna, or auricle, is a highly visible structure. The decision is a very personal one and each individual will have different medical factors, microtia configurations and expectations that must be addressed.
This ear prosthesis allows the family to know what it is like to handle and wear a silicone ear prosthesis on a daily basis. Various adhesives may be used to secure this auricular prosthesis and to create a more seamless blending with the patient’s skin.
The shaping of the ear prosthesis occurs over and around the patient’s own microtia ear. The Slip-Over type of auricular prosthesis is tissue-sparing and may be appropriate before any attempt at surgical ear reconstruction or removal of the microtia ear tissue for installation of osseointegrated implants. It is one we embrace with confidence and enthusiasm, because it is our specialty. This ambitious approach courts failure and success simultaneously, but the challenge is typical for us. We have therefore carefully designed the ear prosthesis to lift and hold the helical remnant ear tissue into its ideal position to restore corrected symmetry and balance for the patient – a feeling of being restored the patient is needing. The frontal view without prosthesis demonstrates a problem the patient encounters following partial or subtotal auriculectomy when his unsupported ear tissue droops and falls away from the side of the head. Adhesive may be applied under the margins for a secure seal, and a superior prosthesis flange is included in the design if the patient wants further stabilization of the prosthesis by the ear piece of his eyeglasses. The partial ear prosthesis in this case is molded to slip into the triangular fossa and cymba conchae like a puzzle piece and is anchored in the precise location. Partial or subtotal auriculectomy is treated without great difficulty, and the cartilaginous structure of the ear remnant is often used to support or suspend the prosthesis. This is a helpful option before taking the drastic and irreversible step of having their natural ear tissue constructions surgically removed for osseointegrated implants. It allows them time to know the nature of prosthesis wear and decide if the slip-over version is perhaps suitable for their own lifestyle. This approach gives the patient a chance to see what it is like to have and wear prostheses each day. over the underlying ear shape is extremely painstaking, but if done with care and precision the enhanced anatomy can accomplish the beauty and grace that many long to see so they can wear their hair back. Creating the delicate shapes of the helix, antihelix, tragus, etc. In ideal cases like this the prosthesis can be slipped on and off in seconds using a small amount of water soluble lubricant, and requires only simple soaping and rinsing for daily care. Slip-over silicone auricular prostheses in many cases attain excellent aesthetics and stay in place nicely by engaging the underlying ear cartilage undercuts. Although this might ultimately be the best long term prosthetic attachment method for many of our patients, there is for some the option to spare their ear constructions by creating a slip-over type prosthesis that greatly improves the anatomical aesthetics of the ear.
AURICULA MEANING ANATOMY SKIN
The surgical removal of the ear would be followed by further thinning of soft tissue in the area and attachment of that skin to the bone periosteum for the installation of osseointegration fixtures and abutments. It is generally true that the implant-retained type prosthesis would require complete sacrifice of the ear construct. This is because they are told or they assume that their ear cartilage constructs must be completely surgically removed for the installation of osseointegrated implants. Patients and families are understandably conflicted in deciding whether to accept and live with the shape of their surgically constructed ears or to have more normally shaped prosthetic ears.
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