Plastik, Rekonstrüktif ve Estetik Cerrahi/Makale Koleksiyonu

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https://hdl.handle.net/20.500.12395/15621

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Treatment Selection for de Quervain’s Tenosynovitis Based on the Michigan’s Hand Questionnaire
(Selçuk Üniversitesi, 2023 Haziran) Koplay, Tuğba Gün; Yıldıran, Gökçe; Çaltıner, İbrahim; Doğramacı, Ahmet Rıfat; Tosun, Zekeriya
Objective: De Quervain’s disease is a stenosing tenosynovitis of the first dorsal compartment. Treatment options include conservative measures, injections, and surgery. The main purpose of this study is to eliminate uncertainty in the choice of treatment and to recommend the appropriate treatment to the patient based on Michigan hand questionnaire. Material and Methods: The age, sex, and treatment modality of the patients were recorded retrospectively. Patients’ Michigan outcomes were assessed, and patients were divided into three groups: Patients who benefited from conservative treatments (Group 1), from injections (Group 2), and from surgery (Group 3). Statistical analysis of the data was performed. Results: The mean age of the 56 patients (54 women, 2 men) was 35.1±11.4 years. There was a difference between all groups in total hand function and pain scores (p < 0.05). Patients in group 1 were significantly different from the other groups (p < 0.05), and there was no significant difference between group 2 and group 3 (p > 0.05). Conclusion: Various methods have been described for De Quervain’s tenosynovitis’s treatment. Choosing the right therapeutic steps for the right patients is important. It is possible to select treatment options by assessing overall hand function and activities of daily living with the Michigan Hand Outcome Questionnaire.
Increased Fat Graft Survival with Mesenchymal Stem Cell Recruiting Effect of PRP: In Vitro and In Vivo Study of Application Techniques
(Selçuk Üniversitesi, 2022) Yıldıran, Gökçe; Çiçek, Gülsemin; Artaç, Hasibe; Uçaryılmaz, Hülya; Duman, Selcuk; Sütçü, Mustafa; Aktan, Tahsin Murad; Tosun, Zekeriya; Akdağ, Osman; Çelik, Z. Esin
Aim: Adding platelet-rich plasm (PRP) or mesenchymal stem cells are the most accepted methods to increase fat graft’s permanence. However, there is no consensus on timing and whether the effect of stem cells or PRP is observed more in the recipient area or in the donor area. It is aimed to present the application method and localization of PRP to be combined with fat graft to increase the survival. Material and Methods: in vitro part: Fat grafts were kept in a medium containing PRP. Cell output from the fat graft to the Petri dishes was examined every day. The time to recruit the maximum number of stem cells to the medium was determined (day 10). in vivo part: Eight group of rats were received PRP in different concentrations either to recipient or donor areas of fat grafts. After ten days, fat grafts were transferred to the recipient area. Ninety days after the transfer, histopathological examination and immunohistochemical staining were performed. Results: The group which had received the full-dose PRP to the recipient area showed the highest cellular integrity and vascularity (p< 0.05). Vascularity was superior in the half-dose PRP group compared to the control group (p< 0.05); cellular integrity did not increase. Donor site groups did not show increase in cellular integrity. Conclusion: Although PRP starts to increase fat graft permanence by increasing vascularity, it acts by preserving the cellular integrity of the fat cells as the concentrations increase. The PRP injection to the recipient area 10 days before fat grafting may provide higher survival rates.
Surgical treatment of complex metacarpophalangeal joint dislocation
(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2020) Sütçü, Mustafa; Yıldıran, Gökçe; Akdağ, Osman
Dorsal dislocations of the metacarpophalangeal joint (MPJ) are relatively uncommon injuries. Complex dislocations of metacarpophalangeal dorsal dislocations are characterized with extended MPJ without flexion and flexed distal joints. Complex dislocation injuries usually require surgical reduction. A 25-year-old male patient was admitted with pain, swelling, and tingling following a hyperextension injury. X-rays demonstrated dorsal dislocation of the proximal phalanx of the index finger without fracture. Open surgical reduction was planned via volar approach. Treating a complex MPJ dislocation with closed reduction is rarely successful. Especially, the volar approach is useful in open dislocations, and anatomy of the volar structures can be best explored and demonstrated.
Long-Term outcomes of digital nerve repair accompanied by digital artery Injury in flexor zone 2
(THIEME MEDICAL PUBL INC, 2020) Yıldıran, Gökçe; Sütçü, Mustafa; Akdağ, Osman; Tosun, Zekeriya
Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the "unrepaired artery group" (UA) and 24 patients in the "intact artery group" (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.
Indications for transoral endoscopic-assisted methods in condylar process fractures
(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2020) Akdağ, Osman; Sütçü, Mustafa; Yıldıran, Gökçe Ünal; Bilirer, Ahmet
Objective: Endoscopic-assisted mandibular subcondylar fracture repair is a different way of performing open reduction internal fixation and also includes surgical equipment and manipulations other than those used in the classical methods. The criteria for patient selection should be different from that of the classical methods. Materials and Methods: Between April 2012 and June 2017, treatment protocols which were applied to 56 patients with mandibular subcondylar fracture were evaluated retrospectively. The first step of this study was to evaluate why patients with mandibular subcondylar fractures were not operated endoscopically. In 34 patients, methods other than endoscopic methods were used. Characteristics of these patients and fractures were demonstrated. Results: Twenty-four patients were followed conservatively. Twenty-two patients were treated with transoral endoscopic method while ten patients were treated with the conventional open surgery. This open surgical treatment was reported by determined the patient records for why the endoscopic method was not preferred. The determined criteria were; condyle with excessive medial deviation, patient age, fracture type, general condition/anesthesia risk, and time of injury. Conclusion: In accordance with clinical experience, some criteria have been defined for patient selection preoperatively in mandibular subcondylar fractures. It believes that with the right patient selection, it will be possible to achieve better results and reduce complications.
Vascularity of the proximal fibula and its implications in vascularized epiphyseal transfer: An anatomical and high-resolution computed tomographic angiography study
(LIPPINCOTT WILLIAMS & WILKINS, 2019) Morsy, Mohamed; Sur, Yoo Joon; Akdağ, Osman; Sabbagh, M. Diya; Suchyta, Marissa A.; El-Gammal, Tarek A.; Lachman, Nirusha.; Moran, Steven L.
Background: Various vascular pedicles have been used to supply the proximal fibula for vascularized epiphyseal transfer. The optimal pedicle has, however, not been agreed on. This study aimed to describe the detailed vascular anatomy of the proximal fibula to assist the surgeon in choosing the optimal pedicle. Methods: Twenty-eight lower extremities were injected with latex or a mixture of latex and barium sulfate. Vessels supplying the proximal fibula were identified and dissected, and the course, diameter, anatomical relations, length, and branches were documented. In the barium group, high-resolution computed tomographic scanning was conducted before dissection. In seven specimens, branches of the deep peroneal nerve to the tibialis anterior muscle were carefully preserved, and their relation to the proximal fibular vascularity was noted. Results: An anastomotic vascular network supplied the proximal fibula. This was formed superiorly by branches of the inferior lateral genicular artery, and inferiorly by branches of the anterior tibial artery, the most important of which were the first and second recurrent epiphyseal arteries. One or more deep peroneal nerve branches passed deep to the first recurrent epiphyseal artery in all specimens examined. In five specimens, all of the branches were superficial to the second recurrent epiphyseal artery, whereas two had branches deep to it. Conclusions: The proximal fibula can be transferred using the inferior lateral genicular or anterior tibial artery because of the existing anastomosis. Factors including length of pedicle, potential for nerve injury, and diaphyseal portion to be harvested should be considered in the pedicle choice.
Role Of Active Range Of Motion İn Hand And Wrist Joint Photography: A Preliminary Analysis
(LIPPINCOTT WILLIAMS & WILKINS, 2019) Yıldıran, Gökçe; Sütçü, Mustafa; Akdağ, Osman; Işık, Cemil; Tosun, Zekeriya
Introduction: Hand photography is effective and advantageous for assessing functional deficits and improvements related to surgery. In this study, it is aimed to investigate whether the correct active range of motion (ROM) is masked by the passive ROM in a wrist joint. Method: Eleven patients who were treated for unilateral wrist fractures were included in the study. Photography was performed in all patients by the same surgeon according to the conventional hand surgery photography approach and the active ROM photography approach. Differences between the noninjured side and injured side were assessed. Results: No differences were found between the active ROM and passive ROM during the extension and flexion movements in the noninjured side group. However, in the injured side group, the results from the photographs obtained with the conventional method were significantly better than the results from the photographs obtained when the wrist was actively moved. Conclusion: These findings suggest that photographs of wrists during passive motion may affect the results of a treatment or study by showing false positivity. We propose obtaining images of active ROM instead of passive ROM in hand photography.
Replantation of the total skin-only avulsions of fingers
(SPRINGER, 2020) Mersa, Berkan; Özçelik, İsmail Bülent; Yıldıran, Gökçe; Akel, İbrahim; Kabakaş, Fatih
Background Skin-only avulsion is a particular type of avulsion surgery. In this type of injury, tendons, bones, and joints maintain their integrity. In this report, we aimed to report the promising results of replantation in seven fingers with total skin-only avulsions. Methods From 2007 to 2015, 6 patients with a mean age of 34.6 (20-52) who underwent replantation surgery for total skin-only avulsion injuries distal to metacarpophalangeal (MP) joint were evaluated according to the injury type, etiology, level of repair, and the repaired structures. Results Seven fingers of 6 patients were evaluated. The mean repaired artery and vein number were 1.5 (1-2) and 3.8 (3-5), respectively. The mean percentage of partial necrosis in the three fingers and an amputated finger was 25.70%. Three fingers survived completely, whereas three developed partial necrosis which were managed by debridement and full thickness skin grafting. Mean static and dynamic two-point discriminations were 6 mm and 3.83 mm, respectively. The mean ROM degree of PIP/IP joints and DIP joints was 74.1 (60-85) and 56.6 (40-70) degrees, respectively. The mean follow-up was 28.3 months (24-36). Conclusions Skin-only avulsions are a particular type of avulsion injury and very challenging to treat. In order to avoid from the partial necrosis due to the vascular deprivation of perforating branches of the proper digital artery, we recommend repairing both arteries in this type of avulsion. Skin-only replantation results can be successful when several technical details are observed. Level of evidence: Level V, therapeutic study.
Foreign body ınside the tunnel: a rare cause of acute cubital tunnel syndrome
(THIEME MEDICAL PUBL INC, 2019) Yıldıran, Gökçe; Sütçü, Mustafa; Akdağ, Osman; Tosun, Zekeriya
Foreign bodies are common entities found in hand surgery practice. However, they are a very rare cause of the acute cubital tunnel syndrome. A 48-year-old male patient was consulted for cubital tunnel symptoms after 2-day unconscious state in the intensive care unit. The ulnar nerve was explored, a piece of glass was removed inside the cubital tunnel, and the nerve was repaired. However, compression neuropathy symptoms due to the acute trauma are interesting. Nerve laceration with a foreign body should be considered in acute-onset cubital tunnel syndrome, in which the foreign body history of a trauma patient cannot be determined explicitly.
Endoscopic-assisted zygomatic arch fracture repair with a preauricular approach
(SAGE PUBLICATIONS INC, 2019) Akdağ, Osman; Evin, Şeyda Güray; Işık, Cemil; Tosun, Zekeriya
Introduction: Because of numerous negative sequelae with open techniques, endoscopic techniques are beginning to be widely used for maxillofacial fractures. Many endoscopic approaches for this area have been described according to several dissection plans and incisions. The aim of the present study was to report a new surgical incision and dissection method for zygomatic arch fracture that aims at reducing the complication rate of previously defined techniques. Material and Methods: The authors operated on 8 patients with a new endoscopic-assisted surgical technique. This study focused on evaluating the complication rate and surgical comfort of these patients. Results: Of the 8 patients, the plate was palpable in the zygomatic arch in one. No complications occurred due to this technique during the 1-year follow-up. Symmetrical facial contour and inconspicuous scars were obtained in all patients. Average operative time was 3 hours; hospitalization time was 1.6 days. Conclusion: This study demonstrates that an endoscopic-assisted surgical approach with a preauricular mini-incision can be safely performed in isolated multifragment zygomatic arch fractures. Using individually designed plates improved our results. This technique is easy to apply, its cosmetic results are good, and its complication rate is low.
Posterior interosseous flap versus reverse adipofascial radial forearm flap for soft tissue reconstruction of dorsal hand defects
(Türkish Assoc Trauma Emergency Surgery, 2018) Akdağ, Osman; Yıldıran, Gökçe; Sütçü, Mustafa; Karameşe, Mehtap
Our objective was to compare the outcomes of dorsal hand defect reconstruction using a posterior interosseous artery flap (PIAF) and a reverse adipofascial radial forearm flap : From 2008 to 2013, 23 patients who underwent hand soft tissue defect reconstruction with PIAF (11 patients) and patients) were included in this retrospective study. Reconstruction methods were compared in terms of functionality with disability of the arm, shoulder, and hand (DASH) score and range of motion (ROM) and aesthetically with scar assessment. Operation times, length of hospital stay, and donor site problems were compared. RESULTS: We found no statistically significant differences between PIAF and RARFF in terms of ROM, DASH score, and length of hospital stay. Statistically significant differences were found in operation time, scar assessment, and donor site problems between PIAF and RARFF patients. : RARFF showed better results than PIAF in dorsal hand defects, but in RARFF, the major arteries of the hand are sacrificed.
Patient symptoms and magnetic resonance imaging correlation in temporomandibular joint internal derangement
(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2018) Akdağ, Osman; Yıldıran, Gökçe; Karameşe, Mehtap
Background/aim: Temporomandibular joint (TMJ) internal derangements consist of reduced and nonreduecd disc dislocations and are often diagnosed by magnetic resonance imaging (MRI). The main symptom of these derangements is TMJ pain. This study aimed to evaluate whether there is a correlation between TMJ pain and disc dislocation. Materials and methods: One hundred and four patients experiencing pain were evaluated retrospectively with the examination charts that we use routinely in our clinics and MRI. Patients were separated into two main groups as MRI(+) and MRI(-) groups according to their internal derangement findings in MRI. Mean VAS levels were compared between these two groups. Results: There were no significant differences between the MRI(+) and MRI(-) groups and no differences between the reduced disc dislocation group and nonreduced disc dislocation group. Conclusion: Although pain is maybe the most irritating symptom for TMJ patients, it cannot take the diagnostic place of MRI and MRI is still the gold standard method to make the exact diagnose of internal derangement.
Management of huge and extraordinary metal-penetrating injuries to the hand
(AVES, 2018) Akdağ, Osman; Yıldıran, Gökçe; Karameşe, Mehtap
Objective: Foreign-body and penetration injuries of the hand are common emergencies. Metallic foreign bodies are common among all foreign masses; however, the examination of huge bodies differs from that of other metallic masses. The purpose of this study was to clarify an algorithm for the management of the huge metallic masses via our therapeutic approaches for metal-penetrating injuries. Material and Methods: Seven patients who had a huge, metallic object-penetration injury to their upper extremity were included in our study. Patients were classified according to the age, injury type, character of metallic body, injury zone, diagnostic methods, anesthesia type, and treatment received, and an algorithm to approach the management of foreign metallic bodies was clarified. Results: The causes of injury were knitting hook, iron fence, mixer, and metal nail. Plain radiography was performed for all patients. Prophylactic tetanus was administered and urgent exploration in the operation room under tourniquet followed by foreign-body extraction through cutting and not pulling were conducted. No residue was retained. Conclusion: Many patients referred to emergency services with foreign bodies. For diagnosis, the patient's history and a minimum of two-way radiograms are crucial. For treatment, we recommend surgical exploration under general anesthesia and tourniquet and extraction of the metallic body by cutting and not pulling without retaining any residual mass in the operation room.
Temporomandibular eklem artrosentezinin etkinliğinin klinik ve radyolojik bulgularla değerlendirilmesi
(2018) Akdağ, Osman; Koplay, Tuğba Gün; Tosun, Zekeriya
Amaç: Artrosentez temporomandibuler eklem bozukluklarıtedavisinde önemli bir basamak tedavidir. Ekllem boşluğundaninflamatuvar mediatörlerin uzaklaştırılması esasınadayanan bu yöntemin etkinliğinin belirlenmesi önemlidir.Gereç ve Yöntem: Temporomandibuler eklem şikayetleri ilebaşvuran 77 hastaya 2011-2015 yılları arasında artrosentezuygulandı. Çift iğneli yöntemle her bir ekleme yaklaşık300 mL %5’lik ringer laktat solüsyonu ile lavaj yapıldı.Hastaların tamamında ağrı düzeyinin belirlenmesi içinVisual Analogue Scale, fonksiyon için interinsizal mesafeaçıklığı ölçümleri yapıldı. Eklem disk patolojilerini belirlemekiçinse Magnetik rezonans görüntüleme yapıldı. İşlemsonrası 3. ayda aynı parametreler kullanılarak hasta verileritoplandı ve öceki değerlerle karşılaştırıldı.Bulgular: Tüm hastalarda işlem sonrasında Visual AnalogueScale, değerlerinde azalma olduğu, 1 hastada dışındatüm hastaların eklem fonksiyonlarında iyileşme olduğugözlendi. MR görüntülerinde ise disk pozisyonunda anlamlıbir değişikliğin olmadığı gözlendi.Sonuç: Bu çalışmada geniş bir hasta serisinde uygulananartrosentezin etkinliği sayısal verilerle ortaya koyulmayaçalışılmıştır. Temporomandibuler eklem artrosentezi ekekipman istemeyen ve kolay uygulanabilen komplikasyonuaz bir yöntemdir. temporomandibuler eklem bozukluklarındaağrının azaltılması ve fonksiyonun geri dönüşümündeetkin, minimal invaziv bir yöntemdir.
Malignant Triton Tumor of the Oral Cavity: A Rare Occurrence
(Springer Verlag, 2012) Seyhan, Nevra; Tosun, Zekeriya; Avunduk, Mustafa Cihad; Savacı, Nedim
Malignant peripheral nerve sheath tumors (MPNST) arise from Schwann cells or within existing neurofibromas and, as a group, account for approximately 5–10% of all soft tissue sarcomas [1]. Although MPNST may consist of tissues such as glandular epithelium, squamous cell, cartilage, or bones, those which possess only skeletal muscle differentiation are referred to as malignant triton tumor (MTT). The tumor consists of two cell lines, rabdomyoblasts and Schwann cells [2]. Rhabdomyosarcomatous elements were first described by Mason in patients with neurofibromatosis [3]. One third of these tumors arise in the head and neck region and at least one third are associated with neurofibromatosis type 1 [4]. The biological behavior of this tumor is more aggressive than the usual malignant schwannoma. It shows rapid growth, early metastases, and poor prognosis [5] and therefore should be regarded as a distinct clinical entity. We present a case with MTT of the oral cavity which is a rare localization for this tumor.
Lower Eyelid Reconstruction With Tarsoconjunctival Flap in a Xeroderma Pigmentosum Patient
(2012) Seyhan, Nevra; Tosun, Zekeriya; Keskin, Mustafa; Savaci, Nedim
Xeroderma pigmentosum is an autosomal recessive genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet light is deficient. This disorder leads to multiple basal cell carcinomas and other skin malignancies at a young age. The eye is the second most commonly affected organ. We present a case of xeroderma pigmentosum with basal cell carcinoma totally infiltrating the lower eyelid. The reconstruction after excision has been planned with a tarsoconjunctival flap (modified Hughes procedure). This procedure had evolved over the years since it had been first described by Hughes. Some important modifications have led the flap to be used with much success. Our aim is to show that the tarsoconjunctival flap is a reliable option in the reconstruction of total lower eyelid defects, with good functional and esthetic outcomes.
Efficacy of Bipolar Release in Neglected Congenital Muscular Torticollis Patients
(Springer-Verlag Italia s.r.l., 2012) Seyhan, Nevra; Jasharllari, Lorenc; Keskin, Mustafa; Savacı, Nedim
Surgical correction of the congenital muscular torticollis (CMT) is recommended for patients with unsuccessful conservative treatment. The aim of this study is to evaluate the efficacy of surgical release of congenital muscular torticollis in neglected cases. We retrospectively evaluated the data of our patients in terms of age, sex, clinical presentation, localization of the lesion, diagnostic tests, and additional abnormalities. The age at operation ranged from 6 to 23 years. Complete muscular release as determined by pre-operative and postoperative range of motion measurements was achieved in all of the patients by bipolar release. In this study, neck motion and head tilt showed marked improvement with surgical treatment in cases with CMT who were admitted to the hospital lately. Congenital muscular torticollis patients can benefit from surgical intervention above the age of 5. Bipolar release is an adequate and complication-free method.
Reconstruction of Total Lower Lip Defects Using Radial Forearm Free Flap with Subsequent Tongue Flap
(Lippincott Williams & Wilkins, 2010) Keskin, Mustafa; Sütçü, Mustafa; Tosun, Zekeriya; Savacı, Nedim
Subtotal and total reconstruction of the lower lip is a challenge for the plastic surgeon. Large defects extending to the chin area can be difficult to manage with only local flaps, and free flaps are better suited. In an attempt to restore the lower lip with the vermilion, the authors used the radial forearm free flap with anteriorly based ventral tongue flap in 5 patients. The tongue flap is used 3 months after the free flap procedure, and this flap is divided 3 weeks later. The tongue flap transfer, adaptation, and division are done under local anesthesia. In all patients, the aesthetic result was excellent compared with the complexity of the reconstructed defect. Patient compliance was uneventful. Although it is a 3-stage reconstruction, combination of radial forearm flap with the tongue flap offers functional and fine aesthetic results.
Preventing Negative Effects of Smoking on Microarterial Anastomosis
(Lippincott Williams & Wilkins, 2010) Tosun, Zekeriya; Karabekmez, Furkan Erol; Duymaz, Ahmet; Özkan, Adem; Keskin, Mustafa; Avunduk, Mustafa Cihat
Although microsurgery has rapid expanded, problems related to microarterial anastomosis continue. Cigarette smoking is one of the major risks for anastomosis by increasing platelet adhesion, and its effects on endothelial cells. Aim of this article is to study the negative effects of cigarettes on microarterial anastomosis line, and to investigate the protective effects of recombinant human erythropoietin (rHuEPO). Ninety-six Sprague-Dawley male rats were divided into 3 groups: group 1 was the control. Rats in groups 2 and 3 were exposed to cigarette smoke starting 21 days prior to surgery for 3 times a day. In group 3, additional 150 IU/kg rHuEPO was given via subcutaneously every 48 hours after microvascular anastomosis, femoral arterial samples, and blood samples were taken for assessment at 1st, 3rd, 5th, and 7th day. Intimae/media ratios were calculated for morphologic analyses. On morphologic analysis of femoral arteries there were statistically significant differences for all 3 groups at 1st, 3rd, 5th, and 7th days (P < 0, 05). The group that made differences was group 2, according to one-way analysis of variance within 3 groups in all days. Smoking decreases endothelial cells healing and causes more thromboses. rHuEPO can prevent these negative effects of smoking.
Implant-Retained Auricular Prosthesis
(Lippincott Williams & Wilkins, 2010) Demir, Necla; Malkoç, Meral Arslan; Öztürk, A. Nilgün; Tosun, Zekeriya
Auricular defects may result from congenital malformations, injuries from motor vehicle crashes, trauma, or tumor resections. An auricular prosthesis was fabricated for a patient who had an injury from a motor vehicle crash. Extraoral implants and bar-and-clip retention for the proper connection of the auricular prosthesis to implant were used. This prosthesis was acceptable to the patient because of excellent support, retentive abilities, and the patient's appearance.

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