Subperiosteal implants for auricular reconstruction in the setting of significant temporal bone defects

Background: While several techniques have been established in the field of auricular reconstruction, these methods are often inadequate in restoring aesthetic function for cases involving significant defects of the temporal bone, particularly after a lateral temporal bone resection for malignancy. This case series describes a novel approach of auricular reconstruction using subperiosteal implants (IPS Implants Craniofacial Epithesis, KLS Martin Group, Tuttlingen, Germany) at an Australian tertiary cancer referral centre. Methodology: The virtual surgical planning (VSP) process and operative technique for subperiosteal implant-retained auricular prosthetic reconstruction in conjunction with a free flap at our institution is described. A retrospective series of cases performed from November 2023 to July 2024 is presented. Results: Three patients underwent auricular reconstruction with subperiosteal implants. Indications for reconstruction included basal cell carcinoma of the auricle (n = 1) and squamous cell carcinoma involving the ear canals (n = 2). Each patient received one subperiosteal implant (n = 3 retention posts per implant framework). Reconstruction was undertaken with an anterolateral thigh free flap (n = 2) or a radial forearm free flap with adipofascial extension (n = 1). No surgical complications or implant losses were observed in our cohort. Two patients underwent successful loading of an auricular prosthesis 4 and 7 months postoperatively, and retained a functional prosthesis on follow-up. One patient unfortunately died of distant disease at 9 months before prosthesis could be fabricated. Conclusion: Our series supports the feasibility of a subperiosteal implant-retained prosthetic auricular reconstruction after a temporal bone resection in the setting of malignancy. It provides opportunity for a reliable and robust aesthetic rehabilitation after oncological resection. Long-term data is required to establish the reliability and long-term quality-of-life outcomes associated with this novel application of this technique.