A new device for creating and positioning an autogenous cartilage framework during microtia reconstruction.

Abstract

This paper describes the fabrication and use of a three-dimensional appliance, known as the microtia surgical positioner, to more accurately position and better sculpt the autogenous rib cartilage graft during microtia reconstruction. The authors introduce a new device design and surgical application. An impression and plaster cast were made from the patient's auricular defect. On this cast, the artist then created a wax baseplate and an esthetically pleasing wax sculpture of an ideal ear similar to the patient's normal contralateral ear. The surface contour of the patient's auricular defect locked the wax baseplate into a stable position, the ear sculpture was then properly positioned on the baseplate, and the two pieces were joined. The artist made a silicone mold of the wax prototype and casted the clear acrylic resin surgical positioner using that mold. Finally, an opening along the helical portion was drilled in the positioner. Intraoperatively, the positioner locked into the surface contour of the patient's auricular defect, thus assuring accurate positioning of the cartilage graft. The surgeon marked the correct helix position with the device's helix and helical port and used the positioner as a model to guide the carving and assembly of the cartilage framework. Our group successfully created and used a microtia surgical positioner. The positioner guided accurate superior-inferior, anterior-posterior, and rotational placement of the helical portion of the cartilage graft. The surgical positioner also significantly contributed to detailed sculpting of the graft. : Medical artists and surgeons may cooperate to fabricate and use a surgical positioner to guide accurate placement of the cartilage framework and assist with sculpting of the graft for total auricular reconstruction.