Research Reports: Microtia Update

Mr Tom Jovic has produced a new natural biological ink for 3D printing, which is strong enough to be printed into a 3D shapes. This newly developed material can even hold its shape as a whole human ear, and shows promise as an alternative for use in reconstructive surgery.

Microtia – being born with a small or missing ear – affects around one in 6,000 babies in the UK.1 As well as affecting a child’s hearing, looking different may also have a negative impact on their self-esteem as they grow up. Although it’s possible to undergo surgery for ear reconstruction, existing approaches involve removing rib cartilage and can be painful and risky.

Mr Jovic, a plastic surgery trainee at the Welsh Centre for Burns and Plastic Surgery, and Clinical Lecturer at Swansea University, aimed to use tissue engineering to create ear implants using the child’s own stem cells.

He has shown that by combining a material commonly used as a filler in cosmetic surgery, hyaluronic acid (HA), with a novel biological material, nanocelluslose, from a renewable plant source, he could produce a suitable material. Furthermore the laboratory experiments showed that the combination of these two compounds supports the growth and development of cartilage cells and new cartilage. The material also appears to be safe for use in humans, and the cartilage cells in contact with the material survive as expected and behave normally. This is all contributing to building an extremely promising case for the future of 3D printing cartilage tissue with this novel material combination.

“Ultimately, this would mean that children may be one day offered the possibility of having customised, permanent ear implants made with their own living cartilage tissue, printed as an exact match of their missing ear, rather than needing lengthy surgery requiring the removal of ribs,” says Mr Jovic.

He hopes this will provide a safer and effective alternative to conventional reconstructive surgery, improving children’s lives.

The next step, following animal studies, is to progress the work towards use in the clinic within the next five years.

Usually affecting only one ear, microtia can occur either by itself or as part of another syndrome. A child can often experience some degree of hearing loss if they also have an underdeveloped ear canal on the affected side.

“When a baby is born with an ear that hasn’t formed properly, this can cause a lot of anxiety and distress for their parents,” says Mr Jovic. “And looking different from other people may have an impact on the child’s confidence and well-being as they grow up.”

Children and their parents will usually be offered the option of surgical reconstruction, which involves using cartilage from the child’s ribs to create a new ear that is then implanted into their body. But this involves several operations and can cause other problems – such as scarring and pain.

“There is a definite need to find new, safer and less invasive ways to make ear implants for children who are unhappy with their appearance,” says Mr Jovic.

“Our goal is to develop a new approach that will revolutionise ear reconstruction for children born with microtia,” says Mr Jovic.

The research group at Swansea University are currently using innovative 3D-printing technologies to create an exact replica of the child’s missing ear – made out of a plant-based biomaterial loaded with the patient’s own cartilage-producing stem cells.

 “Using an ear implant grown from a child’s own cells would avoid the need to remove tissue from the child’s ribs, sparing them from pain and the risk of complications associated with this procedure,” says Mr Jovic.

Mr Jovic now plans to grow stem cells from human nose tissue in the laboratory – to work out the best way to encourage them to produce cartilage. He will also refine the biomaterial to ensure it is safe and has the best qualities for successful 3D-printing, cartilage formation and surgical implantation.

“If successful, this approach could potentially help children with ear and other facial disfigurements in the future, having a positive impact on many young lives,” says Mr Jovic.

1. British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS): Microtia: http://www.bapras.org.uk/public/patient-information/surgery-guides/ear-surgery/microtia [website accessed 25 July 2019]

Each year, Action Medical Research awards these prestigious grants to develop promising doctors and researchers early in their careers as future leaders in children’s research.