Study On The Application Of 3D Printed Correction Brackets In Infants With Auricular Deformity

Background: Auricular deformity is a common facial deformity that not only affects the physical health of the infants,but also causes psychological damage to the infants and their families,which in turn affects their social interactions [1,2].The treatment of auricular deformities includes both surgical and non-surgical treatment.Surgical treatment is mainly aimed at patients with malformation anomalies and older auricular deformities,while non-surgical treatment is currently the best treatment option for auricular deformities in infants.Surgical tape or bandages,curved orthoses and clip-on earmoulds,and integrated ear orthoses are all commonly used orthodontic braces.Integrated orthoses from various brands(e.g.Earwell,Liang Ear,etc.)are basically of uniform specifications and often cause complications such as unsatisfactory correction and skin pressure damage due to inappropriate size and shape,and are expensive,so their application is limited and difficult to popularise.With the popularity of 3D printing technology,it has been gradually applied in the biomedical field.3D printing technology is widely used in the fields of neurosurgical operation approach,orthopaedic osteotomy guide,bone defect repair in maxillofacial surgery,etc.In plastic surgery,it is currently mostly used for ear reconstruction modelling.3D printed auricular correction brackets are rarely used in infant auricular deformities,our early study showed good results in the application of 3D printed auricular correction brackets to treat auricular deformities in infants,but due to the small number of cases,its therapeutic effects need to be further explored.Objective: To analyse the clinical outcomes of 3D printed correction brackets for the treatment of auricular deformities in infants,with the aim of exploring their feasibility and treatment mode.Methods: The clinical data of 49 cases(80 ears)of infants with auricular deformities treated at the Department of Plastic and Reconstructive Surgery,huaihe Hospital of Henan University from September 2015 to August 2022 were retrospectively analyzed.According to the inclusion and exclusion criteria,34 patients with 55 auricular deformities,including 18 males and 16 females,were finally included in the study.The treated patients followed a strict follow-up process until the end of treatment or until the infant’s family was satisfied.The efficacy and safety of treatment was assessed for all ears.The infants were grouped according to their initial treatment age(divided into A1,A2 and A3 groups),gender(divided into B1 and B2 groups)and type of auricular deformity(divided into C1,C2 and C3 groups),and were classified as excellent(Effectiveness and cure),good(improvement)and poor(no improvement)according to the effectiveness of corrective treatment,and the differences in treatment effectiveness and treatment duration in terms of age at initial treatment,type of auricular deformity and gender were assessed.A caregiver questionnaire was used to measure the subjective satisfaction of the infant’s family.Results: 1.55 ears with auricular deformities were treated and all showed improvement with a clinical efficiency of 100%.The overall efficacy and cure rate was 83.6%.2.The effectiveness and cure rates for the different initial treatment age groups were 96% for Group A1,80% for Group A2 and 40% for Group A3,with statistically significant differences(P = 0.01).The median length of treatment for the 3 groups was: Group A1: 7(7,14)d,Group A2: 21(11,30)d and Group A3: 105(10.5,150.5)d.The differences were statistically significant(P = 0.001).3.The effectiveness and cure rates for male and female were 81.3% for group B1 and 87% for group B2,respectively,with no statistically significant difference(P = 0.85).The median length of treatment for the 2 groups was 21(7,30)d for group B1 and 10(7,14)d for group B2,respectively,with a statistically significant difference(P = 0.012).4.The effectiveness and cure rates for the different auricular deformity types were 64%(16/25)for group C1,100%(23/23)for group C2 and 100%(7/7)for group C3,with statistically significant differences(P = 0.002).The median length of treatment for the 3 groups was: Group C1: 21(7,52.5)d,Group C2: 14(10,21)d and Group C3: 7(5,42)d.The difference was not statistically significant(P = 0.159).5.Age at initial treatment was positively correlated with length of treatment(r = 0.519,P < 0.001)and negatively correlated with treatment outcome(r =-0.378,P = 0.004).6.4 ears had complications(3 ears with skin breakdown and 1 ear with dermatitis)and there was no correlation between age at initial treatment,sex,type of auricular deformity,or length of treatment for complications(r=0.049,P=0.723;r=0.046,P=0.736;r=0.058,P=0.674;r=-0.081,P=0.557).7.The satisfaction rates for the effectiveness and cure and effective groups were 4(4,5),3(2,3),(b=1.142,t=4.363,P<0.001)respectively,and the differences were statistically significant.Conclusion: 1.3D printed correction brackets are safe and effective in the treatment of auricular deformities in infants and provide an individualized and precise treatment for auricular deformities in infants.2.The earlier the age of initial treatment,the better the outcome and the shorter the duration of treatment;the type of auricular deformity has an influence on the outcome,with helical rim deformity and Stahl’s ear being treated better than constricted ear.3.The type of auricular deformity and the treatment outcome affected the satisfaction of the infant’s family,with the treatment outcome being the most important factor.