ORL 2015;77:150–154 DOI: 10.1159/000381919 Received: January 8, 2015 Accepted: March 24, 2015 Published online: May 30, 2015
© 2015 S. Karger AG, Basel 0301–1569/15/0773–0150$39.50/0 www.karger.com/orl
How I Do It
A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction Keguang Chen a Tianyu Zhang a
Yaoyao Fu a
Lin Yang b, c
Peidong Dai b, c
a
Department of Otorhinolaryngology, Head and Neck Surgery and b Experimental Center, Eye and ENT Hospital, Fudan University, and c Hearing Medicine Key Laboratory, National Ministry of Public Health, Shanghai, China
Key Words Microtia · Auricle · Three-dimensional solid model · Three-dimensional printing Abstract Aims: To assist with the accurate fabrication and localization of a costal cartilage framework for auricular reconstruction, three-dimensional (3D) digital and solid templates including the auricle and guide plate were made for microtia patients. Methods: The computed tomography data of 60 patients with microtia were included. The 3D digital template of the auricle and guide plate on the healthy side was shaped using MIMICS software with graphic image processing and 3D reconstruction technology. The 3D digital template on the affected side was produced by mirror technique and made into a solid template for clinical application. Results: All 60 patients had a good result of the location and the appearance of the constructed auricle. The time of operation was decreased by an average of half an hour. An individualized 3D solid model of the reconstructed auricular template on the affected side was successfully produced and used in auricular reconstruction. Conclusions: The new 3D template of the auricle and guide plate may be a major contribution to the engraving, assembling and localization of © 2015 S. Karger AG, Basel the microtia auricle in auricular reconstruction.
Introduction
Dr. Tianyu Zhang Department of Otorhinolaryngology Head and Neck Surgery Eye and ENT Hospital, Fudan University No. 83 Fenyang Road, Shanghai 200031 (China) E-Mail doctortianyuzhang @ 163.com
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
Microtia is one of the common birth defects in otological practice, and the incidence rate may range from 1 in 10,000 to 1 in 20,000 [1, 2]. The hearing problem and the appearance problem are the two main aspects that need to be solved for microtia patients. The appearance
151
ORL 2015;77:150–154 DOI: 10.1159/000381919
© 2015 S. Karger AG, Basel www.karger.com/orl
Chen et al.: A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction
problem is mainly solved by auricular reconstruction. Autologous rib cartilage and MEDPOR implant are the most widely used materials for auricular reconstruction [3]. Due to the compatibility of the graft material and other issues, most surgeons perform auricular reconstruction with autologous cartilage [4]. As is known, the auricle is one of the most delicate superficial organs in human beings. There are 14 delicate structures on it which contain variable individual differences [5]. Surgeons usually adopt a two-dimensional (2D) film method to depict normal auricular shape in the X-rays as a reference to carve the auricular framework. As the appearance of the auricle is determined by its three-dimensional (3D) shape, it is difficult to accurately depict its unique and complex shape with 2D information only. Therefore, it is helpful to produce a 3D model of the auricular template for promoting auricular reconstruction. In this study, we produced 3D models of reconstructed auricular templates on the affected side using reverse engineering, 3D reconstruction techniques and graphic image processing technology. Our method can increase the precision of the intraoperative fabrication of auricular cartilages and the localization of reconstructed auricles. Materials and Methods Data Acquisition All axial images were taken with multidetector row computed tomography (CT; Sensation 16, Siemens Medical Systems) in helical mode. Our scanning procedure followed standard temporal bone imaging protocols. Scans were acquired with a tube voltage of 120.0 kV and a current of 180.0 mA. Images were reconstructed with 0.75-mm-thick sections at 0.5-mm increments, a 512 × 512 matrix of 0.43-mm pixel size and a display field of view of 22.0 × 22.0 cm. Images were displayed at a window center of 700 HU and a window width of 4,000 HU. This study was approved by the Ethics Committee of our institute. Digital Imaging and Communication in Medicine (DICOM) images contain positioning data which define spatial coordinates in the superior-inferior, anterior-posterior and left-right directions. CT DICOM datasets were imported into MIMICS 12.1 software (Materialize, Belgium) for image processing in our study. This software allows users to view CT datasets simultaneously using a set of 2D images and a 3D rendered image for each dataset. Observation was performed with a contrast scale between –1,024 (air) and 2,000 HU (bone). Data Processing and 3D Reconstruction of the Template Firstly, a mask with a threshold range from –435 to 330 HU defined the soft tissue, and the original 3D mask of the auricle and face on the healthy side was extracted. Secondly, a new facial mask was created by transposing the pixels of the original 3D facial mask to the healthy side. Thirdly, the new facial mask and the original one underwent Boolean computing, rotation and cutting to get the guide plate. In order to standardize the guide plate, we defined the level of the inner canthus as the top edge when cutting the mask. Then, the guide plate was merged with the auricular template to obtain the 3D digital temple on the healthy side. Lastly, the desired 3D digital temple on the affected side was achieved by using the midsagittal plane as a mirror (fig. 1). After the established standard of these steps, the reconstruction was performed once by K.C. In this study, the 3D digital template was imported into a 3D printer (Quick450, Xi’an Jiaotong University) to produce a 3D solid template (fig. 2). The 3D template was used in auricular reconstruction at our hospital. A satisfaction survey including 3 categories (highly satisfactory, basically satisfactory, unsatisfactory) was conducted in all postoperative patients.
The 3D template was used in 60 microtia patients at our hospital. The preoperative localization of the 3D solid template was conducted in the microtia patients (fig. 3). The surgeons determined the size of the reconstructed auricle and carved the cartilage framework by observing and contrasting the details of the 3D solid auricle (fig. 4). All 60 patients had a good result of the location and the appearance of the constructed auricle. The operative time was
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
Results
152
ORL 2015;77:150–154 © 2015 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000381919
a
b
c
d
Color version available online
Chen et al.: A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction
Color version available online
Fig. 1. Schematic diagrams of a 3D digital template. 3D reconstruction by shaded surface display, which can display the surface image in the form of gray-scale encoding according to the selected threshold. a Anterior view of the 3D reconstruction of a 26-year-old adult with left microtia. b The reconstructed 3D digital template on the healthy side. c Anterior view of the reconstructed 3D digital template on the affected side. d Lateral view of the reconstructed 3D digital template on the affected side.
a
b
Color version available online
Fig. 2. Schematic diagrams of a 3D solid template on the affected side. a Anterior view of the 3D solid template on the affected side. b Lateral view of the 3D solid template on the affected side.
b
Fig. 3. The preoperative localization of the 3D solid template in a microtia patient. a Anterior view of the patient wearing the 3D solid template. b Lateral view of the patient wearing the 3D solid template.
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
a
153
ORL 2015;77:150–154 © 2015 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000381919
Color version available online
Chen et al.: A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction
a
b
c
Fig. 4. The clinical application of the 3D solid template on the affected side. a Localization of the reconstructed auricle. b The precision of intraoperatively engraving auricular cartilages. c Postoperative effect of the reconstructed auricle.
decreased by an average of half an hour compared to the traditional 2D film method. Fiftyfour microtia patients were highly satisfied with the operative results, 6 microtia patients were basically satisfied, and no one considered the results unsatisfactory. An individualized 3D solid model of the reconstructed auricular template on the affected side was successfully produced and used in auricular reconstruction.
With the advancement of orthopedic technologies, patients raise higher aesthetic expectations for auricular appearance. The 2D film method has been used to depict the normal auricular shape in the X-rays as a reference to carve an auricular framework, which presented difficulties in meeting the needs of sophisticated plastic surgery, i.e. carving the auricle with ideal layering and locating it with accurate position. In recent years, the development of 3D printing technology has made the rapid manufacturing of 3D solid models possible. Combining rapid prototyping technology with 3D reconstruction technology based on CT data can produce anatomical models with high precision [6]. With the 3D model of the auricle, errors due to various anthropogenic factors when drawing a 2D film model can be avoided, the amount of carved cartilage frameworks fully estimated and the waste of costal cartilage, which may cause thoracic deformity in some cases, minimized. The 3D model also facilitates a delicate auricle carving close to the contralateral one in the aspects of the height and direction of the helix and antihelix, the depth of triangular fossa and concha cavity and other details. Moreover, it provides some references for the size of the auriculocranial angle in the second-stage operation of auricular reconstruction and helps to build a 3D database to study the growth trend and morphological change of the auricles for clinical research. Kelley et al. [7] first used 3D synthetic templates in the cartilage carving and assembling process. Jiao et al. [8] reconstructed 3D models of healthy ears in patients with ear defects using CT data and produced entity models made of silicone rubber. There was a notable development in the use of CT-captured modeling of costal cartilage in acrylic polyurethane to aid in the preoperative planning phase of auricular reconstruction [9]. Walsh et al. [10] fabricated and used a positioner to guide the localization of the cartilage framework and assist with the sculpting of the graft for total auricular reconstruction. However, one disadvantage of this technique was that a surgeon unfamiliar with facial prosthetics or materials of prosthetic dentistry will need the help of a medical artist to fabricate the positioner. Above all, the methods were not conducive for general practitioners to grasp and were not popular due to the complicated steps and time-consuming procedure. Therefore, we devised the above-mentioned highaccuracy and convenient method to produce an individualized 3D template on the affected side.
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
Discussion
154
ORL 2015;77:150–154 DOI: 10.1159/000381919
© 2015 S. Karger AG, Basel www.karger.com/orl
Chen et al.: A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction
As is known, microtia affects mostly the right side (58–61%), and in the majority (ca. 70–90%), it is unilateral [11]. In cases of unilateral microtia patients, most researchers contend that the ideal reconstructed ear model is an equal-sized mirror-image of the contralateral normal ear [10]. Many software systems have been created to make these mirror-image models of the normal contralateral ear [12, 13], so we used this method to produce an auricular template. This may contribute a lot to the engraving, assembling and localization of the microtia auricle in auricular reconstruction. However, some microtia patients have some extent of hemifacial microsomia on the affected side, which means the face on this side is smaller compared to that on the healthy side. Making an accurate copy of the normal side would not lead to an ideal reconstructed ear. Therefore, if both sides are involved, each side can vary in complexity. Conclusions
In conclusion, the establishment of a 3D template on the affected side in microtia patients can be used by surgeons in auricular reconstruction for a finer carving and more accurate localization. Acknowledgments This work was supported in part by a State Natural Science Fund project provided by the Chinese government (Grant No. 81070786) and the Innovative Research Team in University of the Ministry of Education of China (Grant No. IRT1010).
Disclosure The authors have no financial interest in any of the products or devices mentioned in this article.
1 2 3 4 5 6 7 8 9 10 11 12 13
Kösling S, Omenzetter M, Bartel-Friedrich S: Congenital malformations of the external and middle ear. Eur J Radiol 2009;69:269–279. Colletti V, Soli SD, Carner M, Colletti L: Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window. Int J Audiol 2006;45:600–608. Juilland N, Pasche P: Ear reconstruction in case of microtia (in French). Rev Med Suisse 2012;8:1866–1870. Osorno G: A 20-year experience with the Brent technique of auricular reconstruction: pearls and pitfalls. Plast Reconstr Surg 2007;119:1447–1463. Chin W, Zhang R, Zhang Q, Xu Z, Li D, Wu J: Modifications of three-dimensional costal cartilage framework grafting in auricular reconstruction for microtia. Plast Reconstr Surg 2009;124:1940–1946. Kahrs LA, Labadie RF: Freely-available, true-color volume rendering software and cryohistology data sets for virtual exploration of the temporal bone anatomy. ORL J Otorhinolaryngol Relat Spec 2013;75:46–53. Kelley TF, Moulton-Barrett R, Dugan FM, Crumley RL: The use of 3-dimensional models in auricular reconstruction. Arch Otolaryngol Head Neck Surg 1998;124:335–338. Jiao T, Zhang F, Huang X, Wang C: Design and fabrication of auricular prostheses by CAD/CAM system. Int J Prosthodont 2004;17:460–463. Miyamoto J, Miyamoto S, Nagasao T, Kasai S, Kishi K: Preoperative modeling of costal cartilage for the auricular reconstruction of microtia. Plast Reconstr Surg 2011;128:23e–24e. Walsh WE, Reisberg DJ, Danahey DG: A new device for creating and positioning an autogenous cartilage framework during microtia reconstruction. Laryngoscope 2005;115:2068–2071. Swartz JD, Faerber EN: Congenital malformations of the external and middle ear: high-resolution CT findings of surgical import. Am J Neuroradiol 1985;6:71–76. Park GC, Wiseman JB, Clark WD: Correction of congenital microtia using stereolithography for surgical planning. Plast Reconstr Surg 2000;105:1444–1447. Kaneko T: A system for three-dimensional shape measurement and its application in microtia ear reconstruction. Keio J Med 1993;42:22–40.
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
References
© 2015 S. Karger AG, Basel 0301–1569/15/0773–0150$39.50/0 www.karger.com/orl
How I Do It
A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction Keguang Chen a Tianyu Zhang a
Yaoyao Fu a
Lin Yang b, c
Peidong Dai b, c
a
Department of Otorhinolaryngology, Head and Neck Surgery and b Experimental Center, Eye and ENT Hospital, Fudan University, and c Hearing Medicine Key Laboratory, National Ministry of Public Health, Shanghai, China
Key Words Microtia · Auricle · Three-dimensional solid model · Three-dimensional printing Abstract Aims: To assist with the accurate fabrication and localization of a costal cartilage framework for auricular reconstruction, three-dimensional (3D) digital and solid templates including the auricle and guide plate were made for microtia patients. Methods: The computed tomography data of 60 patients with microtia were included. The 3D digital template of the auricle and guide plate on the healthy side was shaped using MIMICS software with graphic image processing and 3D reconstruction technology. The 3D digital template on the affected side was produced by mirror technique and made into a solid template for clinical application. Results: All 60 patients had a good result of the location and the appearance of the constructed auricle. The time of operation was decreased by an average of half an hour. An individualized 3D solid model of the reconstructed auricular template on the affected side was successfully produced and used in auricular reconstruction. Conclusions: The new 3D template of the auricle and guide plate may be a major contribution to the engraving, assembling and localization of © 2015 S. Karger AG, Basel the microtia auricle in auricular reconstruction.
Introduction
Dr. Tianyu Zhang Department of Otorhinolaryngology Head and Neck Surgery Eye and ENT Hospital, Fudan University No. 83 Fenyang Road, Shanghai 200031 (China) E-Mail doctortianyuzhang @ 163.com
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
Microtia is one of the common birth defects in otological practice, and the incidence rate may range from 1 in 10,000 to 1 in 20,000 [1, 2]. The hearing problem and the appearance problem are the two main aspects that need to be solved for microtia patients. The appearance
151
ORL 2015;77:150–154 DOI: 10.1159/000381919
© 2015 S. Karger AG, Basel www.karger.com/orl
Chen et al.: A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction
problem is mainly solved by auricular reconstruction. Autologous rib cartilage and MEDPOR implant are the most widely used materials for auricular reconstruction [3]. Due to the compatibility of the graft material and other issues, most surgeons perform auricular reconstruction with autologous cartilage [4]. As is known, the auricle is one of the most delicate superficial organs in human beings. There are 14 delicate structures on it which contain variable individual differences [5]. Surgeons usually adopt a two-dimensional (2D) film method to depict normal auricular shape in the X-rays as a reference to carve the auricular framework. As the appearance of the auricle is determined by its three-dimensional (3D) shape, it is difficult to accurately depict its unique and complex shape with 2D information only. Therefore, it is helpful to produce a 3D model of the auricular template for promoting auricular reconstruction. In this study, we produced 3D models of reconstructed auricular templates on the affected side using reverse engineering, 3D reconstruction techniques and graphic image processing technology. Our method can increase the precision of the intraoperative fabrication of auricular cartilages and the localization of reconstructed auricles. Materials and Methods Data Acquisition All axial images were taken with multidetector row computed tomography (CT; Sensation 16, Siemens Medical Systems) in helical mode. Our scanning procedure followed standard temporal bone imaging protocols. Scans were acquired with a tube voltage of 120.0 kV and a current of 180.0 mA. Images were reconstructed with 0.75-mm-thick sections at 0.5-mm increments, a 512 × 512 matrix of 0.43-mm pixel size and a display field of view of 22.0 × 22.0 cm. Images were displayed at a window center of 700 HU and a window width of 4,000 HU. This study was approved by the Ethics Committee of our institute. Digital Imaging and Communication in Medicine (DICOM) images contain positioning data which define spatial coordinates in the superior-inferior, anterior-posterior and left-right directions. CT DICOM datasets were imported into MIMICS 12.1 software (Materialize, Belgium) for image processing in our study. This software allows users to view CT datasets simultaneously using a set of 2D images and a 3D rendered image for each dataset. Observation was performed with a contrast scale between –1,024 (air) and 2,000 HU (bone). Data Processing and 3D Reconstruction of the Template Firstly, a mask with a threshold range from –435 to 330 HU defined the soft tissue, and the original 3D mask of the auricle and face on the healthy side was extracted. Secondly, a new facial mask was created by transposing the pixels of the original 3D facial mask to the healthy side. Thirdly, the new facial mask and the original one underwent Boolean computing, rotation and cutting to get the guide plate. In order to standardize the guide plate, we defined the level of the inner canthus as the top edge when cutting the mask. Then, the guide plate was merged with the auricular template to obtain the 3D digital temple on the healthy side. Lastly, the desired 3D digital temple on the affected side was achieved by using the midsagittal plane as a mirror (fig. 1). After the established standard of these steps, the reconstruction was performed once by K.C. In this study, the 3D digital template was imported into a 3D printer (Quick450, Xi’an Jiaotong University) to produce a 3D solid template (fig. 2). The 3D template was used in auricular reconstruction at our hospital. A satisfaction survey including 3 categories (highly satisfactory, basically satisfactory, unsatisfactory) was conducted in all postoperative patients.
The 3D template was used in 60 microtia patients at our hospital. The preoperative localization of the 3D solid template was conducted in the microtia patients (fig. 3). The surgeons determined the size of the reconstructed auricle and carved the cartilage framework by observing and contrasting the details of the 3D solid auricle (fig. 4). All 60 patients had a good result of the location and the appearance of the constructed auricle. The operative time was
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
Results
152
ORL 2015;77:150–154 © 2015 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000381919
a
b
c
d
Color version available online
Chen et al.: A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction
Color version available online
Fig. 1. Schematic diagrams of a 3D digital template. 3D reconstruction by shaded surface display, which can display the surface image in the form of gray-scale encoding according to the selected threshold. a Anterior view of the 3D reconstruction of a 26-year-old adult with left microtia. b The reconstructed 3D digital template on the healthy side. c Anterior view of the reconstructed 3D digital template on the affected side. d Lateral view of the reconstructed 3D digital template on the affected side.
a
b
Color version available online
Fig. 2. Schematic diagrams of a 3D solid template on the affected side. a Anterior view of the 3D solid template on the affected side. b Lateral view of the 3D solid template on the affected side.
b
Fig. 3. The preoperative localization of the 3D solid template in a microtia patient. a Anterior view of the patient wearing the 3D solid template. b Lateral view of the patient wearing the 3D solid template.
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
a
153
ORL 2015;77:150–154 © 2015 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000381919
Color version available online
Chen et al.: A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction
a
b
c
Fig. 4. The clinical application of the 3D solid template on the affected side. a Localization of the reconstructed auricle. b The precision of intraoperatively engraving auricular cartilages. c Postoperative effect of the reconstructed auricle.
decreased by an average of half an hour compared to the traditional 2D film method. Fiftyfour microtia patients were highly satisfied with the operative results, 6 microtia patients were basically satisfied, and no one considered the results unsatisfactory. An individualized 3D solid model of the reconstructed auricular template on the affected side was successfully produced and used in auricular reconstruction.
With the advancement of orthopedic technologies, patients raise higher aesthetic expectations for auricular appearance. The 2D film method has been used to depict the normal auricular shape in the X-rays as a reference to carve an auricular framework, which presented difficulties in meeting the needs of sophisticated plastic surgery, i.e. carving the auricle with ideal layering and locating it with accurate position. In recent years, the development of 3D printing technology has made the rapid manufacturing of 3D solid models possible. Combining rapid prototyping technology with 3D reconstruction technology based on CT data can produce anatomical models with high precision [6]. With the 3D model of the auricle, errors due to various anthropogenic factors when drawing a 2D film model can be avoided, the amount of carved cartilage frameworks fully estimated and the waste of costal cartilage, which may cause thoracic deformity in some cases, minimized. The 3D model also facilitates a delicate auricle carving close to the contralateral one in the aspects of the height and direction of the helix and antihelix, the depth of triangular fossa and concha cavity and other details. Moreover, it provides some references for the size of the auriculocranial angle in the second-stage operation of auricular reconstruction and helps to build a 3D database to study the growth trend and morphological change of the auricles for clinical research. Kelley et al. [7] first used 3D synthetic templates in the cartilage carving and assembling process. Jiao et al. [8] reconstructed 3D models of healthy ears in patients with ear defects using CT data and produced entity models made of silicone rubber. There was a notable development in the use of CT-captured modeling of costal cartilage in acrylic polyurethane to aid in the preoperative planning phase of auricular reconstruction [9]. Walsh et al. [10] fabricated and used a positioner to guide the localization of the cartilage framework and assist with the sculpting of the graft for total auricular reconstruction. However, one disadvantage of this technique was that a surgeon unfamiliar with facial prosthetics or materials of prosthetic dentistry will need the help of a medical artist to fabricate the positioner. Above all, the methods were not conducive for general practitioners to grasp and were not popular due to the complicated steps and time-consuming procedure. Therefore, we devised the above-mentioned highaccuracy and convenient method to produce an individualized 3D template on the affected side.
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
Discussion
154
ORL 2015;77:150–154 DOI: 10.1159/000381919
© 2015 S. Karger AG, Basel www.karger.com/orl
Chen et al.: A New Three-Dimensional Template for the Fabrication and Localization of an Autogenous Cartilage Framework during Microtia Reconstruction
As is known, microtia affects mostly the right side (58–61%), and in the majority (ca. 70–90%), it is unilateral [11]. In cases of unilateral microtia patients, most researchers contend that the ideal reconstructed ear model is an equal-sized mirror-image of the contralateral normal ear [10]. Many software systems have been created to make these mirror-image models of the normal contralateral ear [12, 13], so we used this method to produce an auricular template. This may contribute a lot to the engraving, assembling and localization of the microtia auricle in auricular reconstruction. However, some microtia patients have some extent of hemifacial microsomia on the affected side, which means the face on this side is smaller compared to that on the healthy side. Making an accurate copy of the normal side would not lead to an ideal reconstructed ear. Therefore, if both sides are involved, each side can vary in complexity. Conclusions
In conclusion, the establishment of a 3D template on the affected side in microtia patients can be used by surgeons in auricular reconstruction for a finer carving and more accurate localization. Acknowledgments This work was supported in part by a State Natural Science Fund project provided by the Chinese government (Grant No. 81070786) and the Innovative Research Team in University of the Ministry of Education of China (Grant No. IRT1010).
Disclosure The authors have no financial interest in any of the products or devices mentioned in this article.
1 2 3 4 5 6 7 8 9 10 11 12 13
Kösling S, Omenzetter M, Bartel-Friedrich S: Congenital malformations of the external and middle ear. Eur J Radiol 2009;69:269–279. Colletti V, Soli SD, Carner M, Colletti L: Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window. Int J Audiol 2006;45:600–608. Juilland N, Pasche P: Ear reconstruction in case of microtia (in French). Rev Med Suisse 2012;8:1866–1870. Osorno G: A 20-year experience with the Brent technique of auricular reconstruction: pearls and pitfalls. Plast Reconstr Surg 2007;119:1447–1463. Chin W, Zhang R, Zhang Q, Xu Z, Li D, Wu J: Modifications of three-dimensional costal cartilage framework grafting in auricular reconstruction for microtia. Plast Reconstr Surg 2009;124:1940–1946. Kahrs LA, Labadie RF: Freely-available, true-color volume rendering software and cryohistology data sets for virtual exploration of the temporal bone anatomy. ORL J Otorhinolaryngol Relat Spec 2013;75:46–53. Kelley TF, Moulton-Barrett R, Dugan FM, Crumley RL: The use of 3-dimensional models in auricular reconstruction. Arch Otolaryngol Head Neck Surg 1998;124:335–338. Jiao T, Zhang F, Huang X, Wang C: Design and fabrication of auricular prostheses by CAD/CAM system. Int J Prosthodont 2004;17:460–463. Miyamoto J, Miyamoto S, Nagasao T, Kasai S, Kishi K: Preoperative modeling of costal cartilage for the auricular reconstruction of microtia. Plast Reconstr Surg 2011;128:23e–24e. Walsh WE, Reisberg DJ, Danahey DG: A new device for creating and positioning an autogenous cartilage framework during microtia reconstruction. Laryngoscope 2005;115:2068–2071. Swartz JD, Faerber EN: Congenital malformations of the external and middle ear: high-resolution CT findings of surgical import. Am J Neuroradiol 1985;6:71–76. Park GC, Wiseman JB, Clark WD: Correction of congenital microtia using stereolithography for surgical planning. Plast Reconstr Surg 2000;105:1444–1447. Kaneko T: A system for three-dimensional shape measurement and its application in microtia ear reconstruction. Keio J Med 1993;42:22–40.
Downloaded by: UCONN Storrs 198.143.38.1 - 6/11/2015 5:04:42 AM
References
