Osseointegrated alloplastic versus autogenous ear reconstruction: criteria for treatment selection

Fifty-five patients with major ear deformities were reconstructed during the period 1982-1993 with autogenous tissue. Fourteen patients were reconstructed with osseointegrated auricular prostheses during the period 1989-1993. Both procedures were done at the same institution by the same surgeon. The advantages and disadvantages of each approach were considered, and our criteria for treatment selection were developed. Our main indications for autogenous reconstruction include classical microtia, relatively normal lower one-third of the ear, patient preference, and less compliant patients. The main indications for osseointegrated alloplastic reconstruction include following major cancer extirpation, poor local tissue, absence of the lower half of the ear, salvage following unsuccessful autogenous reconstruction, and poor operative risks. Because of their success, osseointegrated auricular reconstructions should be added to the armamentarium of the reconstructive surgeon.