AccScience Publishing / IJB / Volume 9 / Issue 6 / DOI: 10.36922/ijb.0898
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3D bioprinting for auricular reconstruction: A review and future perspectives

Anna Onderková* Deepak M. Kalaskar*
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1 University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
Submitted: 4 May 2023 | Accepted: 20 June 2023 | Published: 7 August 2023
(This article belongs to the Special Issue Advances in Bioprinting technology)
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Congenital abnormalities or acquired trauma to the auricle can result in a need for ear reconstruction and negatively impact a person’s quality of life. Autografting, alloplastic implants, and prostheses are available to treat these issues, but each requires multiple surgical stages and has limitations and complications. Three-dimensional (3D) bioprinting promises to allow the creation of living, patient-specific ear substitutes that could reduce operative morbidity. In this review, we evaluate the current state of 3D bioprinting methods through a systematic search and review of 27 studies, aiming to examine this emerging technology within the context of existing reconstructive options. The included studies were all non-randomized experimental studies, except for a single pilot clinical trial. Most of these studies involved both in vitro and in vivo experiments demonstrating the potential of 3D bioprinting to create functional and anatomically accurate engineered cartilaginous frameworks for surgical implantation. Various ways of optimizing printing were identified, from choosing the most suitable material and cell type for the construct to addressing scaffold deformation and shrinkage issues. 3D printing has the potential to revolutionize reconstructive ear surgery by creating functional and aesthetically pleasing auricles. While more research into printing parameters, bioinks, cell types, and materials could optimize results, the next step is to conduct long-term in vivo clinical trials in humans.

3D bioprinting
Auricular Reconstruction
Tissue Engineering
Patient-specific Implants
Cartilaginous Frameworks
  1. Humphries S, Joshi A, Webb WR, et al., 2021. Auricular reconstruction: Where are we now? A critical literature review. Eur Arch Oto-Rhino-Laryngol, 279(2): 541–56. https://10.1007/s00405-021-06903-5



  1. Rendón-Medina MA, Hanson-Viana E, Arias-Salazar L, et al., 2022, Auricular total reconstruction with radial forearm prelaminated flap assisted by 3D surface imaging and 3D printing. Plast Reconstr Surg - Glob Open, 10: e4580. https://10.1097/gox.0000000000004580



  1. Apelgren P, Amoroso M, Säljö K, et al., 2018, Skin grafting on 3D bioprinted cartilage constructs in vivo. Plast Reconstr Surg - Glob Open, 6: e1930. https://10.1097/gox.0000000000001930



  1. Brennan JR, Cornett A, Chang B, et al., 2021, Preclinical assessment of clinically streamlined, 3d‐printed, biocompatible single‐ and two‐stage tissue scaffolds for ear reconstruction. J Biomed Mater Res Part B, 109(3): 394–400. https://10.1002/jbm.b.34707



  1. Jovic TH, Stewart K, Kon M, et al., 2020, Auricular reconstruction: A sociocultural, surgical and scientific perspective. J Plast Reconstr Aesthet Surg, 73(8): 1424–1433. https://10.1016/j.bjps.2020.03.025



  1. Horlock N, Vögelin E, Bradbury ET, et al., 2005, Psychosocial outcome of patients after ear reconstruction. Ann Plast Surg, 54(5): 517–524. https://10.1097/



  1. Ross MT, Cruz R, Hutchinson C, et al., 2018, Aesthetic reconstruction of microtia: A review of current techniques and new 3D printing approaches. Virtual Phys Prototyp, 13(2): 117–130. https://10.1080/17452759.2018.1430246



  1. Jang CH, Koo YW, Kim GH, 2020, ASC/chondrocyte-laden alginate hydrogel/PCL hybrid scaffold fabricated using 3D printing for auricle regeneration. Carbohyd Polym, 248: 116776. https://10.1016/j.carbpol.2020.116776



    9.Chung JH, Kade JC, Jeiranikhameneh A, et al., 2020, 3D hybrid printing platform for auricular cartilage reconstruction. Biomed Phys Eng                  Express, 6: 035003. https://10.1088/2057-1976/ab54a7



  1. Dong X, Premaratne ID, Bernstein JL, et al., 2021, Three-dimensional-printed external scaffolds mitigate loss of volume and topography in engineered elastic cartilage constructs. Cartilage, 13(1). https://10.1177/19476035211049556



  1. Jia L, Hua Y, Zeng J, et al., 2022, Bioprinting and regeneration of auricular cartilage using a bioactive bioink based on microporous photocrosslinkable acellular cartilage matrix. Bioact Mater, 16: 66–81. https://10.1016/j.bioactmat.2022.02.032



  1. Justicz N, Dusseldorp JR, Shaye D, 2017, Firmin technique for microtia reconstruction. Oper Tech Otolaryngol Head Neck Surg, 28(2): 90–96. https://10.1016/j.otot.2017.03.005



  1. Nagata S, Maruyama S, 2022, Auricular reconstruction Nagata method. Nagata Microtia and Reconstructive Plastic Surgery Clinic. (accessed November 26, 2022).



  1. Xia H, Zhao D, Zhu H, et al., 2018, Lyophilized scaffolds fabricated from 3D-printed photocurable natural hydrogel for Cartilage Regeneration. ACS Appl Mater Interfaces, 10(35): 31704–31715. https://10.1021/acsami.8b10926



  1. Tang P, Song P, Peng Z, et al., 2021, Chondrocyte-laden Gelma hydrogel combined with 3D printed PLA scaffolds for auricle regeneration. Mater Sci Eng C, 130: 112423. https://10.1016/j.msec.2021.112423



  1. Roopavath UK, Kalaskar DM, 2022, Introduction to three-dimensional printing in medicine, in 3D Printing in Medicine. Woodhead Publishing, Cambridge 1–27. https://10.1016/B978-0-323-89831-7.00008-0




  1. Berens AM, Newman S, Bhrany AD, et al., 2016, Computer-aided design and 3D printing to produce a costal cartilage model for simulation of auricular reconstruction. Otolaryngol Head Neck Surg, 155(2): 356–359. https://10.1177/0194599816639586



  1. Hong CJ, Giannopoulos AA, Hong BY, et al., 2019, Clinical applications of three‐dimensional printing in otolaryngology–head and neck surgery: A systematic review. The Laryngoscope, 129(8): 2045–2052. https://10.1002/lary.27831



  1. Beckers O, Coppey E, Mommaerts MY, 2021, Computer-aided design and manufacturing construction of a pilot guide for a bone-anchored epithesis to replace an absent pinna. Int J Oral Maxillofac Surg, 50(7): 815–819. https://10.1016/j.ijom.2020.10.006



  1. Zhou G, Jiang H, Yin Z, et al., 2018, In vitro regeneration of patient-specific ear-shaped cartilage and its first clinical application for auricular reconstruction. EBioMedicine, 28(2): 287–302. https://10.1016/j.ebiom.2018.01.011



  1. Mukherjee P, Chung J, Cheng K, et al., 2021, In vitro and in vivo study of PCL-hydrogel scaffold to advance bioprinting translation in microtia reconstruction. J Craniofac Surg, 32(5): 1931–1936. https://10.1097/scs.0000000000007173



  1. Yin Z, Li D, Liu Y, et al., 2020, Regeneration of elastic cartilage with accurate human-ear shape based on PCL strengthened biodegradable scaffold and expanded microtia chondrocytes. Appl Mater Today, 20: 100724. https://10.1016/j.apmt.2020.100724



  1. Landau S, Szklanny AA, Machour M, et al., 2021, Human-engineered auricular reconstruction (hear) by 3D-printed molding with human-derived auricular and costal chondrocytes and adipose-derived mesenchymal stem cells. Biofabrication, 14(1): 015010. https://10.1088/1758-5090/ac3b91



  1. Liao J, Chen Y, Chen J, et al., 2019, Auricle shaping using 3D printing and autologous diced cartilage. The Laryngoscope, 129(12): 2467–2474. https://10.1002/lary.27752



  25. Jia L, Zhang Y, Yao L, et al., 2020, Regeneration of human-ear-shaped cartilage with acellular cartilage matrix-based biomimetic scaffolds.              Appl Mater Today, 20: 100639. https://10.1016/j.apmt.2020.100639



  1. Bhamare N, Tardalkar K, Parulekar P, et al., 2021, 3D printing of human ear pinna using cartilage specific ink. Biomed Mater, 16(5): 055008. https://10.1088/1748-605x/ac15b0



  1. Lee J-S, Hong JM, Jung JW, et al., 2014, 3D printing of composite tissue with complex shape applied to ear regeneration. Biofabrication, 6(2): 024103. https://10.1088/1758-5082/6/2/024103



  1. Visscher DO, Lee H, van Zuijlen PPM, et al., 2021, A photo-crosslinkable cartilage-derived extracellular matrix bioink for auricular cartilage tissue engineering. Acta Biomater, 121(1): 193–203. https://10.1016/j.actbio.2020.11.029



  1. Otto IA, Capendale PE, Garcia JP, et al., 2021, Biofabrication of a shape-stable auricular structure for the reconstruction of Ear Deformities. Mater Today Bio, 9: 100094. https://10.1016/j.mtbio.2021.100094



  1. Kim HY, Jung SY, Lee SJ, et al., 2019, Fabrication and characterization of 3D-printed elastic auricular scaffolds: A pilot study. The Laryngoscope, 129(2): 351–357. https://10.1002/lary.27344



  1. Christen M-O, Vercesi F, 2020, Polycaprolactone: How a well-known and futuristic polymer has become an innovative collagen-stimulator in esthetics. Clin Cosmet Investig Dermatol, 13: 31–48. https://10.2147/ccid.s229054



  1. Zhang X, Battiston KG, McBane JE, et al., 2016, Design of biodegradable polyurethanes and the interactions of the polymers and their degradation by-products within in vitro and in vivo environments. Adv Polyureth Biomater, 75–114. https://10.1016/b978-0-08-100614-6.00003-2



  1. Reighard CL, Hollister SJ, Zopf DA, 2018, Auricular reconstruction from rib to 3D printing. J 3D Print Med, 2(1): 35–41. https://10.2217/3dp-2017-0017



 34. Di Gesù R, Acharya AP, Jacobs I, et al., 2019, 3D printing for tissue engineering in otolaryngology. Connect Tissue Res, 61(2): 117–136.                      https://10.1080/03008207.2019.1663837



  1. Sekar MP, Budharaju H, Zennifer A, et al., 2021, Current standards and ethical landscape of engineered tissues—3D bioprinting perspective. J Tissue Eng, 12(1): 204173142110276. https://10.1177/20417314211027677



  1. European Parliament, Council of the European Union. Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC. Official Journal of the European Union. 2017 [cited 2023 Jun 7]. ht t p s : / / e u r- l e x . e u ropa . e u / l e g a l - c ontent / E N / TXT/?uri=CELEX:02017R0745-20200424



  1. European Parliament, Council of the European Union. Regulation (EC) No 1394/2007 of the European Parliament and of the Council of 13 November 2007 on advanced therapy medicinal products and amending Directive 2001/83/EC and Regulation (EC) No 726/2004. Official Journal of the European Union. 2007 [cited 2023 Jun 7]. ht t p s : / / e u r- l e x . e u ropa . e u / l e g a l - c ontent / E N / ALL/?uri=CELEX%3A32007R1394



  1. European Parliament, Council of the European Union. Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use. Official Journal of the European Communities. 2001 [cited 2023 Jun 7]. do?uri=CELEX:32001L0086:EN:HTML



  1. Ali K, Mohan K, Liu Y-C, 2017, Otologic and audiology concerns of microtia repair. Semin Plast Surg, 31(2): 127–133. https://10.1055/s-0037-1603957



  1. Lipan M, Eshraghi A, 2011, Otologic and audiology aspects of microtia repair. Semin Plast Surg, 25(4): 273–278. https://10.1055/s-0031-1288919



  1. Mota C, Milazzo M, Panetta D, et al., 2018, 3D fiber deposited polymeric scaffolds for external auditory canal wall. J Mater Sci: Mater Med, 29(10). https://10.1007/s10856-018-6071-3



  42. Matin-Mann F, Gao Z, Schwieger J, et al., 2022, Individualized, additively manufactured drug-releasing external ear canal implant for                       prevention of postoperative restenosis: Development, in vitro testing, and proof of concept in an individual curative trial. Pharmaceutics,               14(6): 1242. https://10.3390/pharmaceutics14061242



  1. Kozin ED, Black NL, Cheng JT, et al., 2016, Design, fabrication, and in vitro testing of novel three-dimensionally printed tympanic membrane grafts. Hear Res, 340: 191–203. https://10.1016/j.heares.2016.03.005



  1. Hirsch JD, Vincent RL, Eisenman DJ, 2017, Surgical reconstruction of the ossicular chain with custom 3D printed ossicular prosthesis. 3D Print Med, 3(15). https://10.1186/s41205-017-0015-2



  1. 3DBio Therapeutics, 2022, Aurinovo for auricular reconstruction. ClinicalTrialsgov. (accessed December 7, 2022).



  1. Everett H, 2022, 3DBio conducts successful human ear reconstruction with 3D bioprinted Aurinovo implant. 3D Printing Industry. (accessed December 7, 2022).



  1. Chang B, Cornett A, Nourmohammadi Z, et al., 2020, Hybrid three‐dimensional–printed ear tissue scaffold with autologous cartilage mitigates soft tissue complications. The Laryngoscope, 131(E5): 1008–1015. https://10.1002/lary.29114



  1. Dong X, Askinas C, Kim J, et al., 2022, Efficient engineering of human auricular cartilage through mesenchymal stem cell chaperoning. J Tissue Eng Regen Med, 16(6): 825–835. https://10.1002/term.3332



  1. Park JY, Choi Y-J, Shim J-H, et al., 2017, Development of a 3D cell printed structure as an alternative to autologs cartilage for auricular reconstruction. J Biomed Mater Res Part B Appl Biomater, 105(4): 1016–1028. https://10.1002/jbm.b.33639



   50. Visscher DO, Bos EJ, Peeters M, et al., 2016, Cartilage tissue engineering: Preventing tissue scaffold contraction using a 3D-printed                          polymeric cage. Tissue Eng Part C: Methods, 22(6): 573–584. https://10.1089/ten.tec.2016.0073



  1. Visscher DO, Gleadall A, Buskermolen JK, et al., 2018, Design and fabrication of a hybrid alginate hydrogel/poly(ε‐ caprolactone) mold for auricular cartilage reconstruction. J Biomed Mater Res Part B: Appl Biomater, 107(6): 1711–1721. https://10.1002/jbm.b.34264



  1. Zopf DA, Mitsak AG, Flanagan CL, et al., 2014, Computer aided–designed, 3-dimensionally printed porous tissue bioscaffolds for craniofacial soft tissue reconstruction. Otolaryngol–Head Neck Surg, 152(1): 57–62. https://10.1177/0194599814552065



  1. Xie X, Wu S, Mou S, et al., 2022, Microtissue‐based bioink as a chondrocyte microshelter for DLP bioprinting. Adv Healthc Mater, 11(1): 2201877. https://10.1002/adhm.202201877



  1. Zopf DA, Flanagan CL, Mitsak AG, et al., 2018, Pore architecture effects on chondrogenic potential of patient-specific 3-dimensionally printed porous tissue bioscaffolds for auricular tissue engineering. Int J Pediatr Otorhinolaryngol, 114: 170–174. https://10.1016/j.ijporl.2018.07.033



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International Journal of Bioprinting, Electronic ISSN: 2424-8002 Print ISSN: 2424-7723, Published by AccScience Publishing