Ear scaffolds: Emerging implant technology and approach for prominent ear surgeryEar scaffolds: Emerging implant technology and approach for prominent ear surgery

Ear scaffolding is a minimally invasive surgical approach to correction of prominent ears that employs a metal implant currently being tested in animal models. According to their developer, the implants, called Ear Scaffolds, reshape the ear cartilage, correcting ear asymmetries via a simple and speedy procedure that offers advantages over current gold standard otoplasty techniques.

Prominent ears occur in approximately five percent of the population and, according to Norbert V. Kang, M.B.B.S., M.D., F.R.C.S. (Plast), a plastic surgeon at the Royal Free Hospital in London, England, those with protruding ears go to great lengths to try to camouflage or correct the asymmetry.

SCAFFOLD SOLUTION Dr. Kang invented Ear Scaffolds — thin, curved metal strips approximately 0.2 mm thick, 4 mm wide and 1.5 cm long — to be used to quickly and easily reshape the cartilage of prominent ears. The implants are made of NiTinol, a metal alloy of nickel and titanium commonly used in surgical implants. The devices have the property of "shape memory;" that is, they are flexible enough to bend with any movement of the ear, but will always return to their original, engineered shape. "Ear Scaffolds come in several different curves and shapes which can cater to the different shapes of ears and the different positions that patients may want their ears to assume following the procedure," Dr. Kang tells Cosmetic Surgery Times. He notes that, with his procedure, unlike in conventional otoplasty, "The patient gets to choose the precise degree of ear pinning and the look they want before treatment."

PROCEDURE SPECS Following the application of a local anesthetic cream for approximately 30 minutes, the implants are inserted through a small incision on the front of the ear, just inside the helix. Anywhere from 1 to 3 of the ear-pinning implants are then placed between the skin and the cartilage, depending on the degree of ear pinning needed or desired by the patient.

The device is inserted using a special applicator that its developer claims permits precise deployment of the ear-pinning implant into the ideal anatomical location under the skin. Once in place, the virtually undetectable implant then assumes its pre-programmed shape, bending the cartilage into the desired position. Finally, the skin is closed with steri-strips. According to Dr. Kang, this virtually atraumatic procedure will be very simple to do and should only take only about 10 minutes to complete per ear. Because of the simplicity and speed of the procedure, he believes that it will be ideal for children or any patient where longer operating times are contraindicated for any reason. The Ear Scaffolds must remain in place for approximately six months to allow for the cartilage to re-model into its new shape, after which time the implants can be removed if the patient so desires.

COMPARISON TREATMENT Dr. Kang says that the current gold standard treatment in terms of pinning back prominent ears is a complicated procedure that has a high complication rate, even in the hands of experts. Standard surgery involves making a large cut around the back of the ear, everting the skin and then either reshaping the cartilage by making cuts in it or placing permanent sutures behind the ear to fold the cartilage into a new shape that effectively bends the ear backwards.

The procedure is usually done in early childhood (5 to 7 years of age) and, therefore, usually requires general anesthesia. The standard procedure takes about one-and-a-half hours to complete — approximately 45 minutes per ear. For an adult, this procedure can be done under a local anesthetic but, according to Dr. Kang, many adults also have difficulties lying still for such a long period of time.