Indian J Dent Adv 2012; 4(2) 872

Prosthetic Rehabilitation forCongenital Defect of the Ear

Burhanpurwala Murtuza A1, Kotipalli Madhavi S2, Swaroop Kumar Magar3,Bhandari Aruna J4, Gangadhar SA5

ABSTRACT:

Maxillofacial Prosthodontics is defined as that branch ofprosthodontics concerned with the restoration and/orreplacement of the stomatognathic & craniofacial structureswith prostheses that may or may not be removed on a regularor elective basis. (GPT-8)

Disfigured individuals lacking eyes, nose, or ears may not besocially acceptable. Loss or a congenitally missing body partcan have both a social and psychological impact on those affected.Despite remarkable advances in surgical management; manydefects, especially those of eyes, nose or ear cannot besatisfactorily repaired by a plastic surgery alone thus bringingin the role of a prosthodontist to work as a full member of therehabilitation team.

Maxillofacial prosthesis aim to improve the aesthetics of patientsand to restore, improve and maintain the health of the hardand soft tissues. The effective accomplishment of these objectivesshould expedite patients' return to society.

This paper presents a case report of a patient with congenitallydefective right ear treated with a custom made silicone auricularprosthesis in room temperature vulcanizing (RTV) siliconematerial.

Key words: Auricular prosthesis, Silicone prosthesis, Earprosthesis

C A S E R E P O R T

doi: ...........................

1Senior LecturerDepartment of Prosthodontics,M.A. Rangoonwala Dental College, Pune.

2Reader3Senior LecturerDepartment of Prosthodontics,Saraswati Dhanawantri Dental College, Parbhani.

4Professor & Guide5Principal, Professor & HeadDepartment of Prosthodontics,Rural Dental College, Loni

Article Info:

Received: April 10, 2012;Review Completed: May, 12, 2012;Accepted: June 7, 2012Published Online: August, 2012 (www. nacd. in)© NAD, 2012 - All rights reserved

Email for correspondence:murtuza_burhan@hotmail.com

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INTRODUCTION

The fabrication of an extraoral facial prosthesis is as much an art as it is a science. The form, colorationand texture of the prosthesis must be as indiscernible as possible with the surrounding natural tissues. Theprosthesis must duplicate the missing facial features so precisely that the patient can appear in societywithout fear of attracting unwanted attention.

Auricular prosthesis is a removable ear prosthesis which artificially restores a part or the entire naturalear. The goal of prosthesis constructed in silicone material is to make them soft, flexible and unnoticeable tothe casual observer.

Auricular prosthesis can be retained by anatomic retention, by use of skin adhesives, spectacles, cap,implants, or by using combinations of the above.

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Indian J Dent Adv 2012; 4(2) 873

CASE REPORT

A 24-year-old male patient was reported to theDepartment of Prosthodontics, Rural DentalCollege, Loni, with a chief complaint of unaestheticlook due to partially missing right ear. Onexamination a congenitally malformed right ear wasseen while the left ear was normal (Figure 1). Afterexamining the patient thoroughly it was decidedthat a custom made auricular prosthesis in roomtemperature vulcanizing silicone (RTV) withanatomic retention would best satisfy the needs ofthe patient.

PROCEDURE

After careful examination of the defect areatreatment was planned for custom made auricularprosthesis. The patient was explained about theprocedure and its limitations. The construction ofauricular prosthesis was done in four stages 1)Impression and working-cast fabrication 2)Sculpturing and making of the ear pattern 3) Moldfabrication and 4) Shade matching and processingof the silicone material with intrinsic coloration.

Positioning of auricular pattern is critical inrelating it to the normal ear. Before making theimpression of both, the defective ear and normal ear,a system of markings superiorly, inferiorly,anteriorly and posteriorly is used. A vertical line ismade with an indelible pencil from above the helix,through the center of the external auditory meatus,and through and beyond the center of the lobe ofthe natural ear and a horizontal line from the helixthrough the center of the external auditory meatusand beyond the tragus of the natural ear. The samelines were then drawn on the defective ear side.

1) Impression and Working Cast Fabrication

The patient was draped and hair was protectedby covering the head with disposable head cap.Facial hair was protected by light application ofpetroleum jelly. The patient’s head was placed onthe padded table with the defective ear facing up. Aring of modeling wax was built around the area tobe recorded. The opening was then placed over thepatient’s ear, forming an effective barrier againstundesirable flow of the alginate material. Thealginate material was hand mixed with water/powder ratio of 1.5 times the normal amount ofwater. The alginate was then carefully applied tothe skin surface of the defective area avoiding airentrapment with the help of a paint brush. Aftersetting of the impression it was then carefully freed

from the skin, removed (Figure 2) and poured inwhite colored dental stone to obtain a model withmarkings on skin transferred to it. (Figure 3)Similarly impression and cast of normal ear was alsoobtained (Figures 2 & 3). White colored dental stonewas preferred because it is easier to determineintensity of characterization of colors duringintrinsic coloring procedure. Impression of rightnormal ear of sibling whose ear shape and sizematches with that of patient was also made and castobtained.

2) Making of Ear Pattern

Impression of sibling’s model ear was made andpoured in wax instead of stone. The resultantpattern was nearly complete with the exception ofsealing down to the patient’s working cast. Thetissue side of wax pattern was softened and adaptedto the patient’s working cast and necessary changeswere made. Try-in of the wax pattern was done forshape, size and fit and patient’s approval was taken(Figure 4).

3) Fabrication of Mold

Specially designed PVC flasks were fabricatedfor processing of RTV silicone. The mold for auricularprosthesis was constructed in three parts to allowremoval of the prosthesis from the mold withouttearing thin, convoluted areas. Prior to investing thecope, indentations were placed in the surface of thedrag portion to ensure proper placement of thesecond part of the three-piece mold. Mixture of stonewas prepared and placed from the surface of the dragto the height of contour of the helix around the entireposterior segment of the ear (Figure 5). After thestone had set, tin-foil substitute was applied andthe cope section of the mold was poured. After thesecond pour of stone had set, dewaxing of the moldwas done (Figure 6).

4) Shade Matching & Processing of theSilicone Material with Intrinsic Coloration

An appointment was fixed and patient wascalled on for mixing and evaluating color for thepatient. First base color is formed by trial and errormixing method followed by laminar glazes. Laminarglazes are layers of color painted individually intothe mold before packing the base color. Applicationof laminar glazes is an attempt to mimic the naturaltexture of human skin. Base color represents theoverall skin tone minus skin characteristics and islightest areas of skin. Base color can be identifiedon the underside of the forearm, along the hairline,

Prosthetic Rehabilitation for Congenital Defect of the Ear Burhanpurwala Murtuza, et, al.

Indian J Dent Adv 2012; 4(2) 874

anterior to the tragus and at the base of helix. Basecolor makes up the bulk of the prosthesis. When thecolor of silicone approaches the desired base color,small amount of the colored silicone is placed in thecenter of a transparent cellophane paper to matchthe colour of silicone to that of skin (Figure 7). Firstthe mold surface is characterized by localizedapplication of color and then the mold is filled withbase color and clamped under pressure at roomtemperature for 24hrs.

PROSTHESIS INSERTION

The silicone auricular prosthesis was retrievedfrom flask and trimmed & finished by means ofscissor and silicone finishing burs. Finishedprosthesis was then delivered to patient. The patientwas also advised skin adhesives. The patient wasshown how to place and remove the prosthesis andwas also educated about its maintenance (Figure8). The patient was recalled after 24 hrs and thenat a monthly interval.

Figure 1: Frontal view and Profile view ofpatient

SUMMARY

Prosthetic rehabilitation is advantageous inthat it is relatively quick, reversible, medicallyuncomplicated procedures to rehabilitate congenitaldefects and also allows the surgical site to be closelymonitored. Silicone elastomers are probably the bestand most widely used material for prostheticrehabilitation. A clear to translucent silicone rubberis compatible with all the intrinsic and extrinsiccoloring systems available. The custom-madeauricular prosthesis is esthetically acceptable andcomfortable for use in patients resulting inpsychological improvement, social behavior andpersonality.

References:1. Branemark, Tolman: Osseointegration in Craniofacial

Reconstruction. Quintessence Publishing Company

2. Taylor: Clinical Maxilllofacial Prosthesis. QuintessencePublishing Company: 2000.

Figure 2: Impressions of right and left ear

Figure 3: Models of Right and left ear

Figure 4: Wax try-in - Frontal view and Profileview

Figure 5: Second piece of flasking done at backof ear in specially made PVC flasks

Figure 6: Dewaxed three piece mold

Figure 7: Matching the base colour withcellophane paper

Figure 8:Final prosthesis - Frontal view and Profile view

Prosthetic Rehabilitation for Congenital Defect of the Ear Burhanpurwala Murtuza, et, al.