PMC5803444_01
Treatment course synopsis
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T1
Following magnetic resonance imaging (MRI) (Figure 1 (Fig. 1)), histopathological confirmation, and multidisciplinary discussion of treatment options, a radical tumor resection was performed. Figure 1 (Fig. 1) illustrates the clinical status of the auricular region prior to initiating implantological treatment. 
Comparison of the adhesive-retained vs. implant-retained epitheses (modified according to [13])
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T2
Herzog is acknowledged; follow-up computer tomography [CT] in Figure 2 (Fig. 2)).
a: Preoperative magnetic resonance imaging (MRI) - axial section (tra tse t1). The hypointense tumor represents a mass of 47.5x43x34.6 mm that infiltrates the caudal meatus acusticus externus and the parotid gland, attaining up to the sternocleidomastoid and nuchal muscles (rT4N1M0). b: Preoperative MRI - axial section (tra tse t1 with contrast agent). The tumor is characterized by inhomogeneous cysteiform contrast agent uptake. c: Preoperative MRI - coronal section (tse t1)
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F1
This epithesis covered the residual cranial concha, thereby providing undercuts and an additional retentive surface (Figure 3 (Fig. 3)).
a: Follow-up imaging - axial computerized tomography (CT) section. Red asterisk indicating the partially resected right mastoid process. b: Follow-up imaging - coronal CT section. Red asterisk indicating the partially resected right mastoid process.
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F2
The definitive epithetic treatment was then conducted following 3D preoperative assessment involving cone beam computerized tomography (CBCT) of the temporal bone (Figure 4 (Fig. 4)).
a: Adhesive retained interim epithesis. Note the preauricular actinic keratosis and scarification after removal (Figure b). b: Lateral view of the right auricular region prior to definitive epithetic treatment. The regional soft tissue is characterized by radioderm, stenosis of the external porus acusticus, residual concha, and voluminous myocutaneous flap.
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F3
Africa). A duplicate of the interim epithesis was used as a drilling splint, based on the preoperative planing (Figure 5 (Fig. 5)).
Preoperative cone beam computerized tomography (CBCT) imaging. a: Axial section. Black asterisk indicating planned cranial implant positions. b: Axial section. Black asterisk indicating planned caudal implant position. c: Coronal section. Black asterisk indicating planned first cranial implant position. d: Coronal section. Black asterisk indicating planned second cranial implant position, red plus marking the external meatus acusticus, and red diamond showing the cochlea. e: Coronal section. Black asterisk indicating planned caudal implant position.
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F4
Two implants were inserted cranialy to the external meatus acusticus, and the remaining one in the residual mastoid process, thus avoiding pneumatized areas (Figure 6 (Fig. 6)).
a Preoperative clinical view of the auricular region. b: Intraoperative view of surgical access route. Blue dots marking the intended implant positions. c: Intraoperative view of the prepared caudal implant bed. Fresh bleeding demonstrating vital bone of the residual mastoid process. d: Intraoperative view of inserted implants parallel to each other. e: Intraoperative view after removal of the insertion pins and fixation of cover screws owing to closed healing.
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F5
During this session, the stenosis of the external porus acusticus was managed using a local rotation flap and full-thickness skin graft from the resected remaining concha (Figure 7a (Fig. 7)). T-Line, Steco, Hamburg, Germany), and the patient was referred to the anaplastologist (Figure 7b (Fig. 7)). The magnetic inserts could easily be removed by a special applicator for cleansing and MRI diagnostics.  Thereafter, wax modellation was performed, which was followed by photo-technical measurement and individualisation (Figure 7c (Fig. 7)). Figure 7d (Fig. 7).