According to the National Birth Defect Prevention Network, one in 8,000 to 10,000 births in the United States results in one of two congenital ear malformations: pinna (a baby is born with only a cartilaginous stump of the ear) or anorexia. complete lack of ear). Because there is no properly shaped ear canal or eardrum to pick up and transmit sound waves, a child with blindness or anorexia usually has partial deafness as well.
Now, thanks to two new tools developed by a Johns Hopkins Medicine resident and former resident, the challenging traditional surgery to create a replacement ear from a patient’s rib cartilage can be performed faster, simpler and more precisely, without wasting valuable tissue, and with the ability to “fit” the new organ to each Sick.
Angelo Leto-Barron, MD, a former resident who received a doctorate in plastic and reconstructive surgery at Johns Hopkins University School of Medicine, is now a pediatric craniofacial plastic surgeon at Nemours Children’s Health in Orlando, Florida. “What makes it really difficult is that building a proper ear requires a bit of technical skill.”
To perform ear reconstruction without the need for such an innate talent, Leto Baron and his colleague, resident of diagnostic and interventional radiology at Johns Hopkins University, Anirud Aron, MD, invented two assistive devices using 3D manufacturing. The first is an easy-to-use carving tool that precisely cuts the rib cartilage removed from the patient to any desired thickness and minimizes tissue waste. The second is a “cookie-cutter-like” piston that uses steel blades – shaped in patterns from a patient’s natural ear – to produce pieces of cartilage that are held together during surgery to form the new organ.
“The cartilage shredder essentially doubles the amount of cartilage tissue available for surgery, which means that less must be harvested to safely produce the entire ear,” Aron says. “We only need two and a half ribs instead of the traditional four from previous technologies – less waste and less patient discomfort.”
Segments of cartilage are placed in the second incisor, and neatly trimmed into the new ear components in minutes rather than hours needed to do so manually with a scalpel.
“Not only is the process faster, but the molding eliminates the cartilage damage that often accompanies sculpting done in previous reconstruction methods,” says Leto Baron. “This makes our system highly repeatable, easy to use, time-efficient, and cost-effective. Best of all, it consistently produces a natural-looking ear that helps children avoid harassment or bullying, and enables adults to do things that others consider important. Taken for granted, it’s like wearing glasses.”
Leto Baron and Aaron recently put their assistive devices to the test in the first human trial of the procedure – a surgical procedure on a teenage patient. The successful result is described in a research letter published in the journal Facial plastic surgery and plastic medicine.
“Our system did exactly what it was designed to do,” says Aaron. “Compared to traditional microearmia and anorexia reconstruction surgery, we used fewer cartilages and followed a standardized procedure for constructing the ear frame and reduced the operating time required for this construction.”
Leto Barron and Aaron explore other uses for their assistive devices by adapting them to build structures as replacements for cartilage of the nose, eyelids, and other facial features that were deformed or lost at birth or damaged from resections of cancer, burns, and other disfiguring events.
The Leto Barone and Arun two-device system has been patent approved.
Other Johns Hopkins Medicine authors of the dissertation are Neha Datta, Thomas Harris, Richard Reddit, and Jordan Steinberg. Also contributing as author is George Samaha at the University of Miami Miller School of Medicine.
The project was funded by a grant from the Limitless Tomorrow Foundation. Leto Barone, Arun and Samaha are the owners of ReconstratA, the company that holds the intellectual property rights for microtia repair devices. Leto Barron is also the founder and president of Reconstruct Together.