{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T02:38:36Z","timestamp":1774319916760,"version":"3.50.1"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP23K09083"],"award-info":[{"award-number":["JP23K09083"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study aimed to present and evaluate a surgical approach for placing a Vibrant Soundbridge\u00ae (VSB) device prior to auricular reconstruction in patients with microtia atresia. The goal was to determine whether an incision line for VSB implantation, located sufficiently posterior to the planned area of auricular reconstruction, could prevent interference with subsequent auricular surgeries and ensure stable hearing outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We retrospectively examined four patients with unilateral microtia who underwent VSB implantation before auricular reconstruction. The incision line was placed approximately 5 cm posterior to the posterior edge of the temporomandibular joint, ensuring that it remained at least 2 cm away from the future area of auricular reconstruction. The VSB implantation procedure involved skin incision, subperiosteal dissection, mastoidectomy, and placement of the VSB implant, with a floating mass transducer attached to the head of the stapes. More than a year later, two-stage auricular reconstruction was performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>All patients underwent successful auricular reconstruction after VSB implantation. During the first stage of costal cartilage grafting, subcutaneous pockets were created without encountering congestion or compromised skin flaps, and the grafted cartilage maintained a good contour. In the second stage of auricular elevation, the mastoid fascial flap was elevated with adequate blood flow, and careful dissection prevented exposure or damage to the VSB device. Postoperatively, the reconstructed auricles exhibited stable contour. Audiometric evaluation revealed no deterioration in hearing outcomes, indicating that the VSB device worked well.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This method allows safe and effective VSB implantation prior to auricular reconstruction, without hindering subsequent procedures. By maintaining an appropriate distance between the incision line and planned area of reconstruction, early hearing rehabilitation and successful auricular reconstruction can be achieved. This approach may serve as a practical standard for treating patients with microtia atresia who require early hearing intervention.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0327240","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T17:23:30Z","timestamp":1753809810000},"page":"e0327240","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["A novel incision design for Vibrant SoundBridge\u00ae\ufe0e implantation prior to auricular reconstruction for microtia"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4840-3875","authenticated-orcid":true,"given":"Naohiro","family":"Ueda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takatoshi","family":"Yotsuyanagi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Yamashita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidekane","family":"Yoshimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Takumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Iwasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunsuke","family":"Yuzuriha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin-ichi","family":"Usami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"issue":"7","key":"pone.0327240.ref001","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1097\/MAO.0000000000000796","article-title":"The Vibrant Soundbridge in children and adolescents: preliminary European multicenter results","volume":"36","author":"H Frenzel","year":"2015","journal-title":"Otol Neurotol"},{"issue":"2","key":"pone.0327240.ref002","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1542\/peds.74.2.206","article-title":"Unilateral hearing impairment in children","volume":"74","author":"FH Bess","year":"1984","journal-title":"Pediatrics"},{"issue":"5","key":"pone.0327240.ref003","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1001\/archotol.130.5.524","article-title":"Speech-language and educational consequences of unilateral hearing loss in children","volume":"130","author":"JEC Lieu","year":"2004","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"1","key":"pone.0327240.ref004","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/lary.20036","article-title":"Application of the Vibrant Soundbridge to unilateral osseous atresia cases","volume":"119","author":"H Frenzel","year":"2009","journal-title":"Laryngoscope"},{"issue":"1","key":"pone.0327240.ref005","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1080\/00016489.2020.1823471","article-title":"Active middle ear implant (vibrant soundbridge) in children with unilateral congenital aural atresia","volume":"141","author":"M Takahashi","year":"2021","journal-title":"Acta Otolaryngol"},{"issue":"8","key":"pone.0327240.ref006","doi-asserted-by":"crossref","DOI":"10.1002\/ccr3.4408","article-title":"Vibrant soundbridge implantation prior to auricular reconstruction with unilateral microtia-atresia","volume":"9","author":"H Yoshimura","year":"2021","journal-title":"Clin Case Rep"},{"issue":"1","key":"pone.0327240.ref007","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/01.prs.0000436828.80947.69","article-title":"Correction of lobule-type microtia: I. The first stage of costal cartilage grafting","volume":"133","author":"T Yotsuyanagi","year":"2014","journal-title":"Plast Reconstr Surg"},{"issue":"9","key":"pone.0327240.ref008","doi-asserted-by":"crossref","DOI":"10.1097\/GOX.0000000000000136","article-title":"Correction of Lobule-type Microtia: Part 2: the stage of ear elevation","volume":"2","author":"T Yotsuyanagi","year":"2014","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"7","key":"pone.0327240.ref009","article-title":"Establishment of a standardized technique for Concha-type microtia-how to incorporate the cartilage frame into the remnant ear","volume":"7","author":"T Yotsuyanagi","year":"2019","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"pone.0327240.ref010","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/00006534-199402000-00004","article-title":"Modification of the stages in total reconstruction of the auricle: Part IV. Ear elevation for the constructed auricle","volume":"93","author":"S Nagata","year":"1994","journal-title":"Plast Reconstr Surg"},{"issue":"6","key":"pone.0327240.ref011","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1159\/000095282","article-title":"Round window stimulation with an implantable hearing aid (Soundbridge) combined with autogenous reconstruction of the auricle - a new approach","volume":"68","author":"J Kiefer","year":"2006","journal-title":"ORL J Otorhinolaryngol Relat Spec"},{"key":"pone.0327240.ref012","article-title":"Simultaneous vibrant soundbridge implantation and 2nd stage auricular reconstruction for microtia with aural atresia","volume":"1","author":"LHY Lim","year":"2011","journal-title":"Audiol Res"},{"key":"pone.0327240.ref013","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.ijporl.2016.05.006","article-title":"Vibrant SoundBridge combined with auricle reconstruction for bilateral congenital aural atresia","volume":"86","author":"D Wang","year":"2016","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"8","key":"pone.0327240.ref014","doi-asserted-by":"crossref","first-page":"966","DOI":"10.3109\/00016480903559749","article-title":"Application of the Vibrant Soundbridge in bilateral congenital atresia in toddlers","volume":"130","author":"H Frenzel","year":"2010","journal-title":"Acta Otolaryngol"},{"key":"pone.0327240.ref015","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1177\/0003489420924058","article-title":"Long-term outcomes of clip coupler implantation in patients with unilateral congenital aural atresia","volume":"129","author":"C Zhao","year":"2020","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"pone.0327240.ref016","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.bjps.2018.11.006","article-title":"Cartilage exposure following autologous microtia reconstruction: an algorithmic treatment approach\u2730","volume":"72","author":"S Cugno","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"9","key":"pone.0327240.ref017","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1177\/10556656221095389","article-title":"Salvage of ear framework exposure following autologous microtia reconstruction: repair strategy for each location of exposure","volume":"60","author":"M Fujioka","year":"2023","journal-title":"Cleft Palate Craniofac J"},{"issue":"2","key":"pone.0327240.ref018","article-title":"New concept for severely burned ear reconstruction: grafting of the frame using banked ear cartilage combined with costal cartilage","volume":"9","author":"T Yotsuyanagi","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"7","key":"pone.0327240.ref019","article-title":"Indications for and limitations of reconstruction of auricular defects with the \u201cmid-moon flap\u201d and evaluation of outcome by the aesthetic numeric analogue score","volume":"11","author":"G Guarro","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"20","key":"pone.0327240.ref020","doi-asserted-by":"crossref","first-page":"6521","DOI":"10.3390\/jcm12206521","article-title":"Reconstructive procedures of the auricular concha after cutaneous oncologic surgery: a systematic review","volume":"12","author":"S Moreno-Vazquez","year":"2023","journal-title":"J Clin Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0327240","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T17:23:35Z","timestamp":1753809815000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0327240"}},"subtitle":[],"editor":[{"given":"Shimpei","family":"Miyamoto,","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":20,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0327240","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,29]]}}}