Personalized 3D-Printed Retainers as A Novel Approach to Maintain the Auricular Morphology After Corrective Surgery for Cryptotia: A Retrospective Study

Personalized 3D-Printed Retainers as A Novel Approach to Maintain the Auricular Morphology After Corrective Surgery for Cryptotia: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Personalized 3D-Printed Retainers as A Novel Approach to Maintain the Auricular Morphology After Corrective Surgery for Cryptotia: A Retrospective Study Jiajun Zhi, Peixu Wang, Lin Lin, Bo Pan, Haiyue Jiang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5638917/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 May, 2025 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract Cryptotia, a congenital auricular deformity, presents both aesthetic and functional challenges. This study evaluates the efficacy of personalized 3D-printed retainers in maintaining auricular morphology following corrective surgery for cryptotia. A total of 69 patients with unilateral cryptotia were enrolled in this single-center retrospective cohort study. All patients underwent corrective surgery, and postoperative management included the use of retainers in the experimental group, while the control group did not use any supportive devices. The effect of surgery and retainers relied on the measurement and analysis of auricular indicators preoperatively, immediately postoperatively, and at the last follow-up. Patient satisfaction was assessed using the Likert scale and Visual Analog Scale. Significant improvements in auricular indicators were observed postoperatively in both groups. At the last follow-up, no statistical significances were observed in the differences of key indicators between the affected and normal ears in the experimental group, whereas significant differences were observed in the control group. The experimental group demonstrated a significantly high satisfaction rate (82.25%). Subgroup analysis revealed that the retainers were particularly effective in patients without the need for free skin grafting. This study highlighted the personalized 3D-printed retainers in maintaining auricular morphology and reducing the recurrence after corrective surgery for cryptotia. Health sciences/Diseases Health sciences/Medical research Physical sciences/Materials science Cryptotia 3D printing Retainer Post-surgery support Recurrence Figures Figure 1 Figure 2 Introduction Cryptotia, often referred to as "buried ear", is a congenital auricular deformity commonly seen in Asian populations. It is characterized by the partial embedding of the upper auricle beneath the temporal scalp skin, resulting in an unclear auriculocephalic sulcus compared to the normal ear 1 , 2 . This deformity not only affects aesthetics but also impairs function 3 . While non-surgical interventions, such as ear molding, are effective in neonates with flexible cartilage, they become less viable as the cartilage hardens with age 4 – 6 . In older patients or those with severe cartilage deformities, surgical correction is often necessary​. However, surgical treatment methods face challenges, including elastic recoil of auricular cartilage and recurrence of deformities. These challenges highlight the need for effective postoperative measures to maintain the corrected auricular shape. The early development of 3D printing began in the 1980s 7 . In recent years, 3D printing technology has increasingly been integrated into medical fields, including disease modeling, tissue engineering, drug testing, personalized medicine, organ development, implants, and more 7 – 12 . Stereolithography (SLA) is a 3D printing technology that offers several advantages over traditional 3D printing methods, including scalability, high resolution, fast printing speed, high precision, and the ability to produce uniformly high-quality finished products 13 , 14 . Wang et al. utilized structured light scanning and SLA 3D printing to develop a personalized retainer for post-otoplasty support. The production process began with structured light scanning to capture the detailed geometry of the ear, generating a digital 3D model. This model was then processed using computer-aided design (CAD) software to create the optimal shape for a retainer. Materials like BioMed Flex 80A resin, known for its biocompatibility and mechanical strength, were used for manufacturing. These retainers were designed to provide consistent support to the auricle, maintaining structural stability and the correction effect 15 . Although the biocompatibility, safety, precise fit, high comfort and patient satisfaction level had been demonstrated, there was a lack of objective data supporting for the effect of retainers in maintaining the auricular morphology after correction surgery for cryptotia. This study aimed to explore the effect of personalized 3D printing retainers in maintaining auricular morphology after correction surgery for cryptotia, and assess their role in reducing recurrence rates, ensuring stable surgical outcomes, and increase patient satisfaction. Methods Participants of this study This single-center, retrospective cohort study was conducted on patients with unilateral cyptotia admitted to Plastic Surgery Hospital, Chinese Academy of Medical Sciences between June 1, 2023, and June 1, 2024. A total of 69 patients were involved in this study. All patients underwent cryptotia correction surgery as introduced below. Written informed consent for the surgery and the use of portrait was obtained from all participants before the surgery. Ethical approval for this study was obtained from the Institutional Review Board of Plastic Surgery Hospital, Chinese Academy of Medical Sciences. All experiments were performed in accordance with relevant named guidelines and regulations. Surgical procedures A Z-shaped incision was designed from the retroauricular hairline edge, auriculocephalic sulcus to the dorsum of the superior antihelix crus, forming two triangular flaps. Local anesthetic containing 10 ml of 0.5% lidocaine with 0.05 ml epinephrine was utilized to administer local infiltration anesthesia to the surgical area. Then, the release of abnormal fibrous adhesions was achieved by subcutaneous dissection outward to the antihelix margin, inward to the auriculocephalic junction, and inferiorly to the conchal cavity. The auricular cartilage was fixed to the retroauricular fascial flap using 5 − 0 absorbable sutures to maintain the stability of the auricular contour. The triangular flap at the superior antihelix dorsum was repositioned posteriosuperiorly to cover the skin defect at the retroauricular hairline edge. The triangular flap near the auriculocephalic sulcus was repositioned anteriorly to cover the retroauricular skin defect. Finally, all the skin incisions were closed with 6 − 0 non-absorbable nylon monofilament sutures. If the area of the triangular skin flap was insufficient to cover the wound, an appropriately sized medium-thickness skin graft can be harvested from the inguinal region using a sharp blade and transplanted to the defect site (Supplementary Figure S1 ). Grouping system Patients were divided into two groups according to their preferences: the experimental group, which continued to wear the retainer postoperatively, and the control group, which did not use any supportive or corrective devices postoperatively. To investigate the influence of the surgical technique on the efficacy of the retainer, patients were further categorized into two subgroups based on intraoperative conditions and the actual surgical procedure performed: Subgroup A included patients with milder deformities and sufficient area of triangular flap, who did not require free skin grafting, while Subgroup B consisted of patients with more severe deformities and insufficient area of triangular flap, necessitating free skin grafting to cover the wound. Data collection and efficacy measures The fabrication and application methods of the retainers have been described in detail in our previous study 15 (Supplementary Figure S2 ). For patients in the experimental group, after the suture removal, they were instructed to wear the retainer for 8 hours daily over a duration of one month. Upon completion of the retention period, they could resume normal daily activities without any requirement. In contrast, patients in the control group were not required to use any supportive or corrective devices for auricular deformity. Patients were required to return to the outpatient clinic for follow-up within 6 months after the surgery. Before, after the surgery and at the last follow-up, photographs of patients were taken. At the same time, 3D scanning of patients’ ears and face was performed using a handheld scanner (Artec Corp., USA). Then, the scanning data was transmitted into Artec Studio 10 software (Artec Corp., USA). The auricular perimeter, width, length and the vertical distance from the highest point of the helix to the skull (defined as “D” in this study) were measured respectively using the measurement function of the software according to the method proposed by Zhi et al 16 (Supplementary Figure S3). The differences of all indicators between immediately after the surgery and the last follow-up were simultaneously calculated. The values of each indicator were collected by two plastic surgeons who were blinded to this study, and then averaged. The efficacy of surgery and retainer was evaluated by comparing the relevant indicators before, after the surgery and at the last follow-up. Patient satisfaction measures Two family members of the patient (or the patient and one family member if the patient was an adult) were required to complete a questionnaire preoperatively and/or at the last follow-up. Likert scale with five points 17 (1 = strongly dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied) focused specifically on the device characteristics introduced by Wang et al 15 . Visual Analog Scale (VAS) 18 were utilized to evaluate patient satisfaction for the aesthetic outcome of the affected ear, with satisfaction rated on a scale from 0 to 10, where 0 represented complete dissatisfaction and 10 represented the highest level of satisfaction. Statistical analysis Data analysis and statistical plotting were completed by using SPSS 26.0 (IBM Corp., Armonk, NY) and GraphPad Prism 10 (GraphPad Software, USA). The normality of the data was tested using the Shapiro-Wilk test. A t-test was employed for the comparison of normally distributed variables. Non-normally distributed data were analyzed using Mann-Whitney U test. One-way analysis of variance (one-way ANOVA) was used for multiple comparisons among groups and comparisons were corrected using the Tukey method. The chi-square test was used for the analysis of the categorical data. P value of less than 0.05 was considered statistically significant. Results A total of 69 patients were included in this study, with 37 patients in the experimental group and 32 patients in the control group. The experimental group included a total of 27 males and 10 females, with a mean age of 5.49 ± 2.19 years (range 2–12 years). The mean follow-up period of the experimental group was 4.65 ± 1.74 months (range 2–6 months). The control group included a total of 20 males and 12 females, with a mean age of 5.43 ± 2.88 years (range 2–11 years). The mean follow-up period of the control group was 4.59 ± 1.68 months (range 2–6 months). There were no significant differences between the two groups in terms of sex distribution (χ2 = 0.87, P = 0.35), affected side (χ2 = 0.28, P = 0.60), age (t = 0.09, P = 0.93), or follow-up period (F = 0.02, p = 0.89). All patients were Asians (Table 1 ). Table 1 Demographic data of participants. SD, standard deviation. Experimental Group Control Group Statistic P value Sex Male 27 20 χ 2 = 0.87 0.35 Female 10 12 Affected side Left 15 11 χ 2 = 0.28 0.60 Right 22 21 Severity Mild 18 17 χ 2 = 0.14 0.71 Severe 19 15 Age, years, mean ± SD 5.49 ± 2.19 5.43 ± 2.88 t = 0.09 0.93 Follow-up period, months, mean ± SD 4.65 ± 1.74 4.59 ± 1.68 z=-0.68 0.95 Ethnicity (%) Asian 37 (100) 32 (100) NA NA Major complications 0 0 NA NA For the experimental group, significant improvements were observed in perimeter (t = -6.08, P = 0.00), width (t = -5.81, P = 0.00), length (t = -4.54, P = 0.00) and D value (t = -19.08, P = 0.00) of the affected ear immediately after the surgery compared with those before the surgery. For the control group, similar results had been shown (t = -4.34, P = 0.00; t = -6.05, P = 0.00; t = -3.84, P = 0.00; t = -12.55, P = 0.00). At the last follow-up, no statistically significant differences were observed between the affected and normal ears in terms of perimeter, width, length, and D value in both the experimental and control groups (P > 0.05), which may indicate stable surgical outcomes with no evident tendency for recurrence overall. However, the maximum size of auricle can be approximately reached at age 14 19,20 , and the growth rate of the affected ear may differ from that of the normal ear postoperatively. Although no significant statistical differences were observed between the affected and normal ears during follow-up, the possibility of slower long-term growth and recurrence in the affected ear still remained. Therefore, to further investigate the role of retainers in maintaining the auricular morphology of the affected ear after the surgery, the differences of each indicator were calculated and analyzed, respectively. In the experimental group, the differences in perimeter (t = -0.32, P = 0.75), width (t = -0.25, P = 0.80), length (t = -1.35, P = 0.18), and D value (t = -1.97, P = 0.06) of the affected ear were not statistically significant compared to those of the normal ear. In contrast, in the control group, significant statistical differences were observed between the affected and normal ears for the differences of perimeter, width, and D value (t = -13.50, P = 0.00; t = -4.83, P = 0.00; t = -5.18, P = 0.00). Moreover, statistical significances were observed in the differences of perimeter, width, and D value of the affected ear in the experimental group compared to those of the control group (t = 5.02, P = 0.00; t = 6.19, P = 0.00; t = 3.11, P = 0.00) (Table 2 , Supplementary Table 1). No major surgery-related complications (such as infection, flap necrosis, or postauricular hematoma) or retainer-related complications (such as local allergic reactions, rashes, pressure sores, ulceration, or infection) were recorded. These findings indicate the satisfactory efficacy of the retainer in maintaining auricular morphology and ensuring normal growth of the affected ear postoperatively (Figs. 1 and 2 ). Table 2 The relevant indexes of auricle before, after the surgery and at the last follow-up (mean ± SD, mm). Experimental Group Perimeter Width Length D value Affected side Normal side Affected side Normal side Affected side Normal side Affected side Normal side Preoperative 85.12 ± 11.87 103.53 ± 10.98 23.01 ± 3.15 29.46 ± 2.38 46.13 ± 5.97 53.16 ± 6.68 3.72 ± 1.63 12.70 ± 2.61 Postoperative 102.25 ± 9.38 103.53 ± 10.98 27.35 ± 3.29 29.46 ± 2.38 52.51 ± 6.09 53.16 ± 6.68 12.26 ± 2.18 12.70 ± 2.61 Last follow-up 103.92 ± 9.22 105.28 ± 10.82 27.73 ± 3.43 29.85 ± 2.40 53.28 ± 6.05 54.18 ± 6.48 12.67 ± 2.12 13.29 ± 2.45 Difference 1.67 ± 1.39 1.75 ± 0.66 0.37 ± 0.31 0.38 ± 0.24 0.77 ± 0.45 1.01 ± 1.00 0.41 ± 0.26 0.59 ± 0.51 Table 2 (continued). Control Group Perimeter Width Length D value Affected side Normal side Affected side Normal side Affected side Normal side Affected side Normal side Preoperative 86.67 ± 11.21 103.33 ± 6.26 24.13 ± 2.79 28.67 ± 2.29 43.93 ± 5.47 50.46 ± 4.98 3.63 ± 1.94 12.61 ± 3.22 Postoperative 101.63 ± 10.86 103.33 ± 6.26 28.20 ± 2.59 28.67 ± 2.29 49.34 ± 5.83 50.46 ± 4.98 11.37 ± 2.90 12.61 ± 3.22 Last follow-up 102.02 ± 10.90 105.08 ± 6.35 28.22 ± 2.60 28.93 ± 2.21 50.05 ± 5.85 51.37 ± 4.67 11.53 ± 2.79 13.17 ± 3.20 Difference 0.38 ± 0.44 1.74 ± 0.37 0.02 ± 0.08 0.26 ± 0.26 0.71 ± 0.48 0.91 ± 0.47 0.16 ± 0.39 0.56 ± 0.20 SD, standard deviation. Due to the varying severity of cryptotia deformities among patients, those who experienced significant intraoperative skin defects or insufficient triangular flap area underwent free skin grafting to cover the wound. To investigate the effect of skin grafting on the retainer's maintenance efficacy, we further divided the patients into two subgroups as introduced above. Subgroup A contained a total of 35 patients, including 18 patients in the experimental group and 17 patients in the control group, a mean age of 5.63 ± 1.59 years, and a mean follow-up time of 4.37 ± 1.83 months. Subgroup B contained a total of 34 patients, including 19 patients in the experimental group and 15 patients in the control group, a mean age of 5.29 ± 2.67 years, and a mean follow-up time of 4.88 ± 1.53 months. The demographic characteristics were summarized in Table 3 . For the analysis of the relevant auricular indicators among each subgroup, the results were similar to those mentioned above and will not be elaborated further (Tables 4 and 5 ). As an important indicator of cryptotia, the D value reflects the severity of the deformity and the effectiveness of the correction surgery. Therefore, we preferentially conducted an intergroup comparison of the differences of the D value of the affected ear. The differences of the D value of patients in subgroup A of the experimental group showed statistical significances compared to those of subgroup A of the control group (0.40 ± 0.24mm vs. 0.04 ± 0.45mm; t = 2.98, P = 0.01), while no significant statistical differences were observed when compared to subgroup B of the experimental (0.40 ± 0.24mm vs. 0.42 ± 0.28mm; t = -0.20, P = 0.85) and control groups (0.40 ± 0.24mm vs. 0.30 ± 0.27mm; t = 1.10, P = 0.28), respectively. Although the differences of the D value of patients in subgroup B of the experimental group were slightly higher than that of patients in subgroup B of the control group, there were no statistical significances in the differences observed (0.42 ± 0.28mm vs. 0.30 ± 0.27mm; t = 1.22, P = 0.23) (Supplementary Figure S4). Similar results were obtained in the intergroup comparisons of the differences of perimeter, length, and width of the affected ear. These results indicate that for patients who did not undergo free skin grafting during surgery, the postoperative maintenance effect of the retainer was significantly better than for those who did. Table 3 Demographic data of participants of each subgroup. Experimental Group Control Group Statistic P value Sex Subgroup A Male 13 11 χ 2 = 0.23 0.72 Female 5 6 Subgroup B Male 14 9 χ 2 = 0.72 0.47 Female 5 6 Age, mean ± SD Subgroup A 5.61 ± 1.61 5.65 ± 1.62 t=-0.07 0.95 Subgroup B 5.37 ± 2.67 5.20 ± 2.76 t=-0.18 0.85 Follow-up period Subgroup A 4.39 ± 1.88 4.35 ± 1.84 z=-0.04 0.97 Subgroup B 4.89 ± 1.59 4.86 ± 1.50 z=-0.02 0.98 Table 4 Comparison of the difference of relevant indexes of subgroup A (mm, mean ± SD). Experimental Group Control Group Affected side Normal side t value P value Affected side Normal side t value P value Difference of perimeter 1.84 ± 1.82 1.74 ± 0.63 0.24 0.81 0.49 ± 0.58 1.59 ± 0.23 -6.79 0.00 Difference of width 0.52 ± 0.15 0.53 ± 0.20 -0.09 0.93 0.02 ± 0.06 0.28 ± 0.32 -3.06 0.00 Difference of length 0.83 ± 0.53 1.02 ± 1.35 -0.59 0.56 0.87 ± 0.32 0.99 ± 0.49 -0.83 0.41 Difference of D value 0.42 ± 0.28 0.48 ± 0.19 -0.82 0.42 0.30 ± 0.28 0.64 ± 0.17 -4.08 0.00 SD, standard deviation. Table 5 Comparison of the difference of relevant indexes of subgroup B (mm, mean ± SD). Experimental Group Control Group Affected side Normal side t value P value Affected side Normal side t value P value Difference of perimeter 1.48 ± 0.74 1.76 ± 0.71 -0.15 0.26 0.28 ± 0.23 1.89 ± 0.41 -13.92 0.00 Difference of width 0.22.±0.36 0.24 ± 0.18 -0.29 0.77 0.03 ± 0.09 0.24 ± 0.20 -3.91 0.00 Difference of length 0.82 ± 0.35 1.02 ± 0.46 -1.42 0.16 0.56 ± 0.55 0.83 ± 0.46 -1.56 0.13 Difference of D value 0.39 ± 0.24 0.72 ± 0.70 -1.81 0.08 0.04 ± 0.45 0.50 ± 0.20 -3.86 0.00 SD, standard deviation. Patient satisfaction was also notably high. Based on the results of the Likert scale, the overall “satisfied” and “very satisfied” rate with the retainer among patients in the experimental group reached 11.77% and 82.25%, respectively. Dissatisfactory results also needed to be taken seriously. Two patients reported being “strongly dissatisfied” with the weight of the retainer, while another 2 patients reported being “dissatisfied”. One patient reported being “strongly dissatisfied” with the durability of the retainer, while 3 patients reported being “dissatisfied”. Regarding wearing comfort, 4 patients reported being “strongly dissatisfied”, and five patients reported being “dissatisfied” (Table 6 ). This reminded us that future improvements to the retainer must focus on using lighter, more flexible, and more comfortable materials to ensure a nearly imperceptible wearing experience. Preoperatively, the Visual Analog Scale (VAS) score for the appearance of the affected ear given by patients in the experimental group (or guardians, similarly hereinafter) was 1.43 ± 0.89. The VAS score significantly improved immediately postoperatively to 7.62 ± 1.40 (z = -7.47, P = 0.00). At the final follow-up, the VAS score increased to 7.90 ± 1.24, with no statistically significant difference compared to the postoperative score (z = -0.34, P = 0.73). The Visual Analog Scale (VAS) score for the appearance of the affected ear given by patients in the control group was 1.54 ± 1.04, and significantly improved immediately postoperatively to 7.43 ± 1.46 (z = -7.51, P = 0.00). At the final follow-up, the VAS score increased to 7.57 ± 1.17, with no statistically significant difference compared to the immediately postoperative score (z = -0.89, P = 0.93). Table 6 The Likert scale for wearing the retainer. Characteristics Number of patients (%) Strongly dissatisfied Dissatisfied Neutral Satisfied Very satisfied Dimension 0 (0) 0 (0) 1 (1.45) 10 (14.49) 58 (84.06) Weight 2 (2.90) 2 (2.90) 3 (4.35) 12 (17.39) 50 (72.46) Adjustability 0 (0) 0 (0) 0 (0) 7 (10.14) 62 (89.86) Safety 0 (0) 0 (0) 0 (0) 1 (1.45) 68 (98.55) Durability 1 (1.45) 3 (4.35) 5 (7.25) 9 (13.04) 51 (73.91) Simplicity of use 0 (0) 3 (4.35) 0 (0) 8 (11.59) 58 (84.06) Comfort 4 (5.80) 5 (7.25) 3 (4.35) 8 (11.59) 49 (71.01) Effectiveness 0 (0) 0 (0) 1 (1.45) 10 (14.49) 58 (84.06) General 0.87 (1.26) 1.63 (2.36) 1.63 (2.36) 8.12 (11.77) 56.75 (82.25) Discussion Non-surgical treatment of cryptotia, such as the use of external corrective devices, is typically suitable for newborns under 6 weeks of age 6 , 21 , 22 . However, due to limited awareness of the condition and other factors, most patients miss the optimal time window for non-surgical intervention. As a result, surgical correction remains the primary treatment for cryptotia. Traditional treatment methods for cryptotia, including Z-plasty, V-Y advancement flaps and skin grafting 23 – 26 , often address skin deficiency but may fall short in achieving long-term stability due to the elastic recoil of the auricular cartilage. Although plastic surgeons have made numerous efforts to prevent postoperative recurrence of cryptotia 27 – 30 , recurrence remains a significant challenge in the treatment of this condition 31 . This study evaluated the efficacy of personalized 3D-printed retainers in maintaining auricular morphology following corrective surgery for cryptotia. In this study, no statistically significant differences were observed between the affected and normal ears in terms of perimeter, width, length, and D value in both the experimental and control groups at the last follow-up, which indicated satisfactory surgical outcomes with no evident tendency for recurrence. The statistical significances observed in differences of relevant auricular indicators between the experimental and control groups highlighted the retainer’s pivotal role in stabilizing the auricular morphology after the surgery. The subgroup analysis revealed a notable interaction between the need for free skin grafting and the effectiveness of the retainers. Patients in Subgroup A, who did not require grafting, exhibited better outcomes with the retainers compared to Subgroup B, who underwent free skin grafting. This may be because patients in Subgroup A had their wound covered solely with a retroauricular triangular skin flap during surgery. Postoperatively, factors such as cartilage recoil, and contraction of scar tissue and the skin flap made it more difficult for these patients to maintain a stable auricular morphology, thus rendering the retainer's role in maintaining postoperative morphology more significant for this subgroup. In contrast, patients in Subgroup B underwent free skin grafting during surgery, which reduced tension on the retroauricular incision. Consequently, the effects of scarring and flap contraction on auricular morphology were minimized, making recurrence less likely and the impact of the retainer less pronounced compared to Subgroup A. Patient satisfaction is also a key indicator of the success of reconstructive procedures. In this study, the result of Likert scale indicated an overall satisfaction rate of 82.25% among patients in the experimental group regarding the retainer. Additionally, both the experimental and control groups showed significant improvement in VAS scores from the preoperative assessment to the last follow-up. At present, 3D printing has been widely applied in the field of auricular reconstruction, including surgical simulation and practice 32 , 33 , intraoperative guide plates production 34 , external corrective devices 35 , and the fabrication and transplantation of ear scaffolds 36 . However, there are currently no reports on the application of 3D printing for postoperative support and morphology maintenance following auricular corrective surgery 37 . By providing anatomically precise, customized devices, our retainer addresses the limitations of traditional postoperative support methods, enhancing the stability of surgical correction, reducing the likelihood of recurrence, and improving patient satisfaction. This method represents a significant advancement in the treatment of auricular deformities. The integration of 3D printing technology into postoperative management offers transformative benefits. Personalized 3D-printed retainers addressed many limitations of traditional supportive devices by providing: (1) Precise Fit and Customization: The retainers were designed based on high-resolution 3D scans of the patient’s affected ear, ensuring an exact fit that adapts to individual anatomical variations; (2) Biocompatibility and Comfort: The use of advanced materials such as BioMed Flex 80A resin ensured that the retainers were both durable and comfortable for long-term wear 15 , 38 , reducing the risk of irritation or pressure sores; (3) Uniform Quality and Reliability: Stereolithography (SLA) enabled the production of retainers with consistent quality and precision, ensuring reliable performance across patients, and (4) Enhanced Aesthetic Outcomes: The ability to maintain the natural contours of the auricle contributes to improved aesthetic results, which are often a primary concern for patients undergoing corrective surgery. While this study provides compelling evidence of the efficacy of 3D-printed retainers, several limitations must be acknowledged. The single-center design and relatively small sample size may limit the generalizability of the findings. Additionally, all patients included in this study were Asian. Multicenter studies with larger cohorts and patients of different nationalities involved are needed to validate these results and establish broader clinical guidelines. Additionally, the follow-up period, although sufficient to evaluate short-term outcomes, may not capture the long-term effects of the retainers on auricular growth and morphology. Future research should focus on longitudinal studies to assess the durability of the outcomes and the impact of the retainers on the natural growth trajectory of the auricle. Another area for exploration is the integration of advanced materials and technologies into the retainer design. For example, incorporating sensors to monitor pressure distribution or using bioresorbable materials could further enhance the functionality and patient experience. Conclusion Personalized 3D-printed retainers represented a significant advancement in the postoperative management of cryptotia. By providing consistent support and maintaining the corrected auricular morphology, these retainers played a pivotal role in achieving stable, aesthetically satisfactory, and functionally effective outcomes. This study underscored the value of integrating cutting-edge technologies like 3D printing into clinical practice to address complex challenges in auricular reconstruction. The promising results paved the way for future innovations in personalized medicine and highlighted the transformative potential of 3D printing in improving the outcomes of auricular reconstructive surgery. Declarations Acknowledgments Mr. Zhi and Mr. Wang contributed equally to this article as co-first authors. Author contributions Jiajun Zhi and Peixu Wang contributed equally to this study. Haiyue Jiang and Lin Lin participated in the design of the study. Jiajun Zhi and Peixu Wang collected and analyzed the data and wrote the article. Haiyue Jiang and Bo Pan critically revised the article. All authors read and approved the final manuscript. Data Availability statement All data generated or analyzed during this study are included in this published article (tables 1-6). Disclosures and Competing interests The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. This study was approved by Institutional Review Board of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences. Consent for publication declaration Written consent forms for the surgery and the use of portrait were obtained from all patients and/or their guardians before the surgery. All patients and/or their guardians voluntarily participated in this study and provided consent for the publication of photographs collected during the study in open-access journals. Funding This work was supported by the Chinese Academy of Medical Science Innovation Fund for Medical Sciences (2021-I2M-052), Beijing Municipal Science & Technology Commission (No. Z221100007422084), Young Scientists Fund of the National Natural Science Foundation of China (Grant No. 8230092675), and Beijing Natural Science Foundation (No.7244400). References Ho, S., Lee, D. & Yellon, R. Cryptotia. Otolaryngol Head Neck Surg 123 , 339 (2000). https://doi.org/10.1067/mhn.2000.105468 Kantu, K., Aretsky, P. J. & Polisar, I. A. Cryptotia. Laryngoscope 82 , 161-165 (1972). https://doi.org/10.1288/00005537-197202000-00001 Li, D. et al. A New Method of Correcting Cryptotia by Changing Mechanical Fulcrum After Constricted Cartilage Overturned. Aesthetic Plast Surg 45 , 2781-2787 (2021). https://doi.org/10.1007/s00266-021-02413-1 Xu, H. et al. The Treatment Effect of Non-Surgical Ear Molding Correction in Children with Mild Cryptotia Deformity. Laryngoscope 133 , 2122-2128 (2023). https://doi.org/10.1002/lary.30491 Wang, D. et al. Non-surgical correction of cryptotia and the analysis of treatment time and other influence factors. Int J Pediatr Otorhinolaryngol 129 , 109771 (2020). https://doi.org/10.1016/j.ijporl.2019.109771 Chia, D. H. & Sim, N. Non-surgical correction of cryptotia. J Plast Reconstr Aesthet Surg 74 , 377-381 (2021). https://doi.org/10.1016/j.bjps.2020.08.133 Crafts, T. D. et al. Three-Dimensional Printing and Its Applications in Otorhinolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 156 , 999-1010 (2017). https://doi.org/10.1177/0194599816678372 Thayer, P., Martinez, H. & Gatenholm, E. History and Trends of 3D Bioprinting. Methods Mol Biol 2140 , 3-18 (2020). https://doi.org/10.1007/978-1-0716-0520-2_1 Choi, J. W. & Kim, N. Clinical application of three-dimensional printing technology in craniofacial plastic surgery. Arch Plast Surg 42 , 267-277 (2015). https://doi.org/10.5999/aps.2015.42.3.267 Bos, E. J. et al. Developing a parametric ear model for auricular reconstruction: a new step towards patient-specific implants. J Craniomaxillofac Surg 43 , 390-395 (2015). https://doi.org/10.1016/j.jcms.2014.12.016 Zhang, Q., Bei, H. P., Zhao, M., Dong, Z. & Zhao, X. Shedding light on 3D printing: Printing photo-crosslinkable constructs for tissue engineering. Biomaterials 286 , 121566 (2022). https://doi.org/10.1016/j.biomaterials.2022.121566 Prabhakaran, P. et al. Prospect and retrospect of 3D bio-printing. Acta Histochem 124 , 151932 (2022). https://doi.org/10.1016/j.acthis.2022.151932 Kumar, H. & Kim, K. Stereolithography 3D Bioprinting. Methods Mol Biol 2140 , 93-108 (2020). https://doi.org/10.1007/978-1-0716-0520-2_6 Deshmane, S., Kendre, P., Mahajan, H. & Jain, S. Stereolithography 3D printing technology in pharmaceuticals: a review. Drug Dev Ind Pharm 47 , 1362-1372 (2021). https://doi.org/10.1080/03639045.2021.1994990 Wang, P. et al. 3D-Printing of retainer for post-otoplasty morphology preservation. IJB 10 (2024). https://doi.org/10.36922/ijb.3986 Zhi, J., Wang, T., Jiang, H. & Yu, X. Auricular growth potential of patients with concha-type microtia after auricular cartilage stretching surgery: A prospective study. J Plast Reconstr Aesthet Surg 97 , 71-79 (2024). https://doi.org/10.1016/j.bjps.2024.07.073 Ruiz, N., Lopez, R. M., Marques, R. & Fontenete, S. Clinical Outcomes and Safety Profile of a Dextranomer-Hyaluronic Acid Hybrid Filler: A Case Series Analysis. J Cosmet Dermatol (2024). https://doi.org/10.1111/jocd.16653 Zhi, J., Feng, J., Zhao, L., Yu, X. & Jiang, H. Auricular deformity correction with simultaneous reconstruction of the conchal bowl using autologous ear cartilage for "flat ear": A novel surgical technique. J Plast Reconstr Aesthet Surg 98 , 398-405 (2024). https://doi.org/10.1016/j.bjps.2024.09.077 Leto Barone, A. A. et al. Characterization of Auricular Growth within the Pediatric Population Using Computed Tomography Scan Measurements. Plast Reconstr Surg Glob Open 11 , e5210 (2023). https://doi.org/10.1097/gox.0000000000005210 Zhao, S. et al. Anthropometric growth study of the ear in a Chinese population. J Plast Reconstr Aesthet Surg 71 , 518-523 (2018). https://doi.org/10.1016/j.bjps.2017.10.010 Zhong, Z., Zhang, J., Xiao, S., Liu, Y. & Zhang, Y. Long-Term Effectiveness of Ear Molding in Infants Using the EarWell Infant Correction System in China. Plast Reconstr Surg 148 , 616-623 (2021). https://doi.org/10.1097/prs.0000000000008293 Xiong, H. et al. Comparison of 2 Ear Molding Systems for Nonsurgical Management of Newborn Auricular Deformities. Ear Nose Throat J 100 , 652s-656s (2021). https://doi.org/10.1177/0145561320901398 Cho, Y. K., Bae, S. G. & Cho, B. C. Comparison between Z-plasty and V-Y Advancement for the Surgical Correction of Cryptotia. Arch Craniofac Surg 15 , 7-13 (2014). https://doi.org/10.7181/acfs.2014.15.1.7 Marsh, D., Sabbagh, W. & Gault, D. Cryptotia correction--the post-auricular transposition flap. J Plast Reconstr Aesthet Surg 64 , 1444-1447 (2011). https://doi.org/10.1016/j.bjps.2011.06.037 Li, H. et al. Cryptotia Repair Using a Modified V-Y Advancement Flap with Helix Rounding Technique. Aesthetic Plast Surg 47 , 640-646 (2023). https://doi.org/10.1007/s00266-022-03050-y Yotsuyanagi, T. et al. Correction of Cryptotia With Double Z-plasty:Modified Large Z-plasty Technique. J Craniofac Surg 34 , 2092-2094 (2023). https://doi.org/10.1097/scs.0000000000009427 Lee, D., Kim, Y. S., Roh, T. S. & Yun, I. S. Cryptotia recurrence lowering technique with additional acellular dermal matrix graft. Arch Craniofac Surg 20 , 170-175 (2019). https://doi.org/10.7181/acfs.2019.00269 Oh, J. H., Park, K. H. & Kim, B. G. Prevention of Recurrence in the Surgical Correction of Cryptotia Using Local Flaps With a Cartilage Wedge Graft. J Craniofac Surg 27 , 461-463 (2016). https://doi.org/10.1097/scs.0000000000002355 Yotsuyanagi, T., Yamashita, K., Shinmyo, Y., Yokoi, K. & Sawada, Y. A new operative method of correcting cryptotia using large Z-plasty. Br J Plast Surg 54 , 20-24 (2001). https://doi.org/10.1054/bjps.2000.3463 Wang, Y. et al. A New Surgical Method of Correcting Abnormal Cartilage in Mild or Moderate Cryptotia. Ann Plast Surg 81 , 662-668 (2018). https://doi.org/10.1097/sap.0000000000001591 Handler, E. B., Song, T. & Shih, C. Complications of otoplasty. Facial Plast Surg Clin North Am 21 , 653-662 (2013). https://doi.org/10.1016/j.fsc.2013.08.001 Mussi, E. et al. Ear Reconstruction Simulation: From Handcrafting to 3D Printing. Bioengineering (Basel) 6 (2019). https://doi.org/10.3390/bioengineering6010014 Jovic, T. H., Combellack, E. J., Jessop, Z. M. & Whitaker, I. S. Using 3D Printing Technology to Teach Cartilage Framework Carving for Ear Reconstruction. Front Surg 7 , 44 (2020). https://doi.org/10.3389/fsurg.2020.00044 Alhazmi, B., Alshomer, F. & Alawirdhi, B. Multiscale sterilizable 3D printed auricular templates to guide cartilaginous framework sizing and sculpture during autologous microtia reconstruction. JPRAS Open 28 , 121-125 (2021). https://doi.org/10.1016/j.jpra.2021.03.004 Argyropoulos, A. & Botsaris, P. N. Modern Applications of 3D Printing: The Case of an Artificial Ear Splint Model. Methods Protoc 4 (2021). https://doi.org/10.3390/mps4030054 Zhou, G. et al. In Vitro Regeneration of Patient-specific Ear-shaped Cartilage and Its First Clinical Application for Auricular Reconstruction. EBioMedicine 28 , 287-302 (2018). https://doi.org/10.1016/j.ebiom.2018.01.011 Liu, Y. et al. Application of 3D printing in ear reconstruction with autogenous costal cartilage: A systematic review. Int J Pediatr Otorhinolaryngol 176 , 111817 (2024). https://doi.org/10.1016/j.ijporl.2023.111817 Keßler, A., Dosch, M., Reymus, M. & Folwaczny, M. Influence of 3D-printing method, resin material, and sterilization on the accuracy of virtually designed surgical implant guides. J Prosthet Dent 128 , 196-204 (2022). https://doi.org/10.1016/j.prosdent.2020.08.038 Additional Declarations No competing interests reported. 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(\u003cstrong\u003eb\u003c/strong\u003e) Photograph at suture removal. (\u003cstrong\u003ec\u003c/strong\u003e) 6-month postoperative result.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5638917/v1/76f146fb7a31867c539596fe.png"},{"id":81582488,"identity":"d11f2d1b-1637-48b0-b5e6-73096e7ee780","added_by":"auto","created_at":"2025-04-28 19:37:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19765186,"visible":true,"origin":"","legend":"\u003cp\u003e(\u003cstrong\u003ea\u003c/strong\u003e) Preoperative photograph of a 4-year-old male patient in control group. (\u003cstrong\u003eb\u003c/strong\u003e) Photograph at suture removal. (\u003cstrong\u003ec\u003c/strong\u003e) 6-month postoperative result.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-5638917/v1/f9b9c4496d397b6ff89fd223.png"},{"id":83782956,"identity":"c5ac9a18-e439-46e8-9a36-ce29c7fe3a38","added_by":"auto","created_at":"2025-06-02 16:09:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":44263249,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5638917/v1/51ab5db2-deb3-44a5-87c6-f7f1868606b8.pdf"},{"id":81582459,"identity":"33cb0ce8-c5cf-497f-9878-dae944b37213","added_by":"auto","created_at":"2025-04-28 19:37:30","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17293,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5638917/v1/d65922db731eda0713288a48.docx"},{"id":81582464,"identity":"d7368d85-f097-4b80-a1d7-af3ed03fc090","added_by":"auto","created_at":"2025-04-28 19:37:30","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":946738,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigures.docx","url":"https://assets-eu.researchsquare.com/files/rs-5638917/v1/4e404723bcbe9054d87d9a68.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Personalized 3D-Printed Retainers as A Novel Approach to Maintain the Auricular Morphology After Corrective Surgery for Cryptotia: A Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCryptotia, often referred to as \"buried ear\", is a congenital auricular deformity commonly seen in Asian populations. It is characterized by the partial embedding of the upper auricle beneath the temporal scalp skin, resulting in an unclear auriculocephalic sulcus compared to the normal ear\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. This deformity not only affects aesthetics but also impairs function\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. While non-surgical interventions, such as ear molding, are effective in neonates with flexible cartilage, they become less viable as the cartilage hardens with age\u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In older patients or those with severe cartilage deformities, surgical correction is often necessary​. However, surgical treatment methods face challenges, including elastic recoil of auricular cartilage and recurrence of deformities. These challenges highlight the need for effective postoperative measures to maintain the corrected auricular shape.\u003c/p\u003e \u003cp\u003eThe early development of 3D printing began in the 1980s\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. In recent years, 3D printing technology has increasingly been integrated into medical fields, including disease modeling, tissue engineering, drug testing, personalized medicine, organ development, implants, and more\u003csup\u003e\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Stereolithography (SLA) is a 3D printing technology that offers several advantages over traditional 3D printing methods, including scalability, high resolution, fast printing speed, high precision, and the ability to produce uniformly high-quality finished products\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Wang et al. utilized structured light scanning and SLA 3D printing to develop a personalized retainer for post-otoplasty support. The production process began with structured light scanning to capture the detailed geometry of the ear, generating a digital 3D model. This model was then processed using computer-aided design (CAD) software to create the optimal shape for a retainer. Materials like BioMed Flex 80A resin, known for its biocompatibility and mechanical strength, were used for manufacturing. These retainers were designed to provide consistent support to the auricle, maintaining structural stability and the correction effect\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Although the biocompatibility, safety, precise fit, high comfort and patient satisfaction level had been demonstrated, there was a lack of objective data supporting for the effect of retainers in maintaining the auricular morphology after correction surgery for cryptotia.\u003c/p\u003e \u003cp\u003eThis study aimed to explore the effect of personalized 3D printing retainers in maintaining auricular morphology after correction surgery for cryptotia, and assess their role in reducing recurrence rates, ensuring stable surgical outcomes, and increase patient satisfaction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants of this study\u003c/h2\u003e \u003cp\u003eThis single-center, retrospective cohort study was conducted on patients with unilateral cyptotia admitted to Plastic Surgery Hospital, Chinese Academy of Medical Sciences between June 1, 2023, and June 1, 2024. A total of 69 patients were involved in this study. All patients underwent cryptotia correction surgery as introduced below. Written informed consent for the surgery and the use of portrait was obtained from all participants before the surgery. Ethical approval for this study was obtained from the Institutional Review Board of Plastic Surgery Hospital, Chinese Academy of Medical Sciences. All experiments were performed in accordance with relevant named guidelines and regulations.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical procedures\u003c/h3\u003e\n\u003cp\u003eA Z-shaped incision was designed from the retroauricular hairline edge, auriculocephalic sulcus to the dorsum of the superior antihelix crus, forming two triangular flaps. Local anesthetic containing 10 ml of 0.5% lidocaine with 0.05 ml epinephrine was utilized to administer local infiltration anesthesia to the surgical area. Then, the release of abnormal fibrous adhesions was achieved by subcutaneous dissection outward to the antihelix margin, inward to the auriculocephalic junction, and inferiorly to the conchal cavity. The auricular cartilage was fixed to the retroauricular fascial flap using 5\u0026thinsp;\u0026minus;\u0026thinsp;0 absorbable sutures to maintain the stability of the auricular contour. The triangular flap at the superior antihelix dorsum was repositioned posteriosuperiorly to cover the skin defect at the retroauricular hairline edge. The triangular flap near the auriculocephalic sulcus was repositioned anteriorly to cover the retroauricular skin defect. Finally, all the skin incisions were closed with 6\u0026thinsp;\u0026minus;\u0026thinsp;0 non-absorbable nylon monofilament sutures. If the area of the triangular skin flap was insufficient to cover the wound, an appropriately sized medium-thickness skin graft can be harvested from the inguinal region using a sharp blade and transplanted to the defect site (Supplementary Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eGrouping system\u003c/h3\u003e\n\u003cp\u003ePatients were divided into two groups according to their preferences: the experimental group, which continued to wear the retainer postoperatively, and the control group, which did not use any supportive or corrective devices postoperatively. To investigate the influence of the surgical technique on the efficacy of the retainer, patients were further categorized into two subgroups based on intraoperative conditions and the actual surgical procedure performed: Subgroup A included patients with milder deformities and sufficient area of triangular flap, who did not require free skin grafting, while Subgroup B consisted of patients with more severe deformities and insufficient area of triangular flap, necessitating free skin grafting to cover the wound.\u003c/p\u003e\n\u003ch3\u003eData collection and efficacy measures\u003c/h3\u003e\n\u003cp\u003eThe fabrication and application methods of the retainers have been described in detail in our previous study\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e (Supplementary Figure \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e). For patients in the experimental group, after the suture removal, they were instructed to wear the retainer for 8 hours daily over a duration of one month. Upon completion of the retention period, they could resume normal daily activities without any requirement. In contrast, patients in the control group were not required to use any supportive or corrective devices for auricular deformity.\u003c/p\u003e \u003cp\u003ePatients were required to return to the outpatient clinic for follow-up within 6 months after the surgery. Before, after the surgery and at the last follow-up, photographs of patients were taken. At the same time, 3D scanning of patients\u0026rsquo; ears and face was performed using a handheld scanner (Artec Corp., USA). Then, the scanning data was transmitted into Artec Studio 10 software (Artec Corp., USA). The auricular perimeter, width, length and the vertical distance from the highest point of the helix to the skull (defined as \u0026ldquo;D\u0026rdquo; in this study) were measured respectively using the measurement function of the software according to the method proposed by Zhi et al\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e (Supplementary Figure S3). The differences of all indicators between immediately after the surgery and the last follow-up were simultaneously calculated. The values of each indicator were collected by two plastic surgeons who were blinded to this study, and then averaged.\u003c/p\u003e \u003cp\u003eThe efficacy of surgery and retainer was evaluated by comparing the relevant indicators before, after the surgery and at the last follow-up.\u003c/p\u003e\n\u003ch3\u003ePatient satisfaction measures\u003c/h3\u003e\n\u003cp\u003eTwo family members of the patient (or the patient and one family member if the patient was an adult) were required to complete a questionnaire preoperatively and/or at the last follow-up. Likert scale with five points\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e (1\u0026thinsp;=\u0026thinsp;strongly dissatisfied, 2\u0026thinsp;=\u0026thinsp;dissatisfied, 3\u0026thinsp;=\u0026thinsp;neutral, 4\u0026thinsp;=\u0026thinsp;satisfied, 5\u0026thinsp;=\u0026thinsp;very satisfied) focused specifically on the device characteristics introduced by Wang et al\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Visual Analog Scale (VAS)\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e were utilized to evaluate patient satisfaction for the aesthetic outcome of the affected ear, with satisfaction rated on a scale from 0 to 10, where 0 represented complete dissatisfaction and 10 represented the highest level of satisfaction.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData analysis and statistical plotting were completed by using SPSS 26.0 (IBM Corp., Armonk, NY) and GraphPad Prism 10 (GraphPad Software, USA). The normality of the data was tested using the Shapiro-Wilk test. A t-test was employed for the comparison of normally distributed variables. Non-normally distributed data were analyzed using Mann-Whitney U test. One-way analysis of variance (one-way ANOVA) was used for multiple comparisons among groups and comparisons were corrected using the Tukey method. The chi-square test was used for the analysis of the categorical data. P value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 69 patients were included in this study, with 37 patients in the experimental group and 32 patients in the control group. The experimental group included a total of 27 males and 10 females, with a mean age of 5.49\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19 years (range 2\u0026ndash;12 years). The mean follow-up period of the experimental group was 4.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74 months (range 2\u0026ndash;6 months). The control group included a total of 20 males and 12 females, with a mean age of 5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88 years (range 2\u0026ndash;11 years). The mean follow-up period of the control group was 4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68 months (range 2\u0026ndash;6 months). There were no significant differences between the two groups in terms of sex distribution (χ2\u0026thinsp;=\u0026thinsp;0.87, P\u0026thinsp;=\u0026thinsp;0.35), affected side (χ2\u0026thinsp;=\u0026thinsp;0.28, P\u0026thinsp;=\u0026thinsp;0.60), age (t\u0026thinsp;=\u0026thinsp;0.09, P\u0026thinsp;=\u0026thinsp;0.93), or follow-up period (F\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;=\u0026thinsp;0.89). All patients were Asians (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of participants. SD, standard deviation.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.49\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up period, months, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ez=-0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor the experimental group, significant improvements were observed in perimeter (t = -6.08, P\u0026thinsp;=\u0026thinsp;0.00), width (t = -5.81, P\u0026thinsp;=\u0026thinsp;0.00), length (t = -4.54, P\u0026thinsp;=\u0026thinsp;0.00) and D value (t = -19.08, P\u0026thinsp;=\u0026thinsp;0.00) of the affected ear immediately after the surgery compared with those before the surgery. For the control group, similar results had been shown (t = -4.34, P\u0026thinsp;=\u0026thinsp;0.00; t = -6.05, P\u0026thinsp;=\u0026thinsp;0.00; t = -3.84, P\u0026thinsp;=\u0026thinsp;0.00; t = -12.55, P\u0026thinsp;=\u0026thinsp;0.00). At the last follow-up, no statistically significant differences were observed between the affected and normal ears in terms of perimeter, width, length, and D value in both the experimental and control groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), which may indicate stable surgical outcomes with no evident tendency for recurrence overall. However, the maximum size of auricle can be approximately reached at age 14\u003csup\u003e19,20\u003c/sup\u003e, and the growth rate of the affected ear may differ from that of the normal ear postoperatively. Although no significant statistical differences were observed between the affected and normal ears during follow-up, the possibility of slower long-term growth and recurrence in the affected ear still remained. Therefore, to further investigate the role of retainers in maintaining the auricular morphology of the affected ear after the surgery, the differences of each indicator were calculated and analyzed, respectively. In the experimental group, the differences in perimeter (t = -0.32, P\u0026thinsp;=\u0026thinsp;0.75), width (t = -0.25, P\u0026thinsp;=\u0026thinsp;0.80), length (t = -1.35, P\u0026thinsp;=\u0026thinsp;0.18), and D value (t = -1.97, P\u0026thinsp;=\u0026thinsp;0.06) of the affected ear were not statistically significant compared to those of the normal ear. In contrast, in the control group, significant statistical differences were observed between the affected and normal ears for the differences of perimeter, width, and D value (t = -13.50, P\u0026thinsp;=\u0026thinsp;0.00; t = -4.83, P\u0026thinsp;=\u0026thinsp;0.00; t = -5.18, P\u0026thinsp;=\u0026thinsp;0.00). Moreover, statistical significances were observed in the differences of perimeter, width, and D value of the affected ear in the experimental group compared to those of the control group (t\u0026thinsp;=\u0026thinsp;5.02, P\u0026thinsp;=\u0026thinsp;0.00; t\u0026thinsp;=\u0026thinsp;6.19, P\u0026thinsp;=\u0026thinsp;0.00; t\u0026thinsp;=\u0026thinsp;3.11, P\u0026thinsp;=\u0026thinsp;0.00) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Supplementary Table\u0026nbsp;1). No major surgery-related complications (such as infection, flap necrosis, or postauricular hematoma) or retainer-related complications (such as local allergic reactions, rashes, pressure sores, ulceration, or infection) were recorded. These findings indicate the satisfactory efficacy of the retainer in maintaining auricular morphology and ensuring normal growth of the affected ear postoperatively (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe relevant indexes of auricle before, after the surgery and at the last follow-up (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, mm).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePerimeter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eWidth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003eLength\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003eD value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.12\u0026thinsp;\u0026plusmn;\u0026thinsp;11.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e103.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e53.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102.25\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e103.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e52.51\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e53.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103.92\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e105.28\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e54.18\u0026thinsp;\u0026plusmn;\u0026thinsp;6.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e(continued).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePerimeter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eWidth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eLength\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eD value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.67\u0026thinsp;\u0026plusmn;\u0026thinsp;11.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50.46\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101.63\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49.34\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50.46\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102.02\u0026thinsp;\u0026plusmn;\u0026thinsp;10.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.05\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eSD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDue to the varying severity of cryptotia deformities among patients, those who experienced significant intraoperative skin defects or insufficient triangular flap area underwent free skin grafting to cover the wound. To investigate the effect of skin grafting on the retainer's maintenance efficacy, we further divided the patients into two subgroups as introduced above. Subgroup A contained a total of 35 patients, including 18 patients in the experimental group and 17 patients in the control group, a mean age of 5.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59 years, and a mean follow-up time of 4.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83 months. Subgroup B contained a total of 34 patients, including 19 patients in the experimental group and 15 patients in the control group, a mean age of 5.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67 years, and a mean follow-up time of 4.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53 months. The demographic characteristics were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e. For the analysis of the relevant auricular indicators among each subgroup, the results were similar to those mentioned above and will not be elaborated further (Tables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e). As an important indicator of cryptotia, the D value reflects the severity of the deformity and the effectiveness of the correction surgery. Therefore, we preferentially conducted an intergroup comparison of the differences of the D value of the affected ear. The differences of the D value of patients in subgroup A of the experimental group showed statistical significances compared to those of subgroup A of the control group (0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24mm vs. 0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45mm; t\u0026thinsp;=\u0026thinsp;2.98, P\u0026thinsp;=\u0026thinsp;0.01), while no significant statistical differences were observed when compared to subgroup B of the experimental (0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24mm vs. 0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28mm; t = -0.20, P\u0026thinsp;=\u0026thinsp;0.85) and control groups (0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24mm vs. 0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27mm; t\u0026thinsp;=\u0026thinsp;1.10, P\u0026thinsp;=\u0026thinsp;0.28), respectively. Although the differences of the D value of patients in subgroup B of the experimental group were slightly higher than that of patients in subgroup B of the control group, there were no statistical significances in the differences observed (0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28mm vs. 0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27mm; t\u0026thinsp;=\u0026thinsp;1.22, P\u0026thinsp;=\u0026thinsp;0.23) (Supplementary Figure S4). Similar results were obtained in the intergroup comparisons of the differences of perimeter, length, and width of the affected ear. These results indicate that for patients who did not undergo free skin grafting during surgery, the postoperative maintenance effect of the retainer was significantly better than for those who did.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of participants of each subgroup.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubgroup A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubgroup B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubgroup A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et=-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubgroup B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et=-0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubgroup A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ez=-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubgroup B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ez=-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the difference of relevant indexes of subgroup A (mm, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003et value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003et value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference of perimeter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-6.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference of width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference of length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference of D value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eSD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the difference of relevant indexes of subgroup B (mm, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003et value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eAffected side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eNormal side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003et value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference of perimeter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-13.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference of width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.22.\u0026plusmn;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference of length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference of D value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eSD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatient satisfaction was also notably high. Based on the results of the Likert scale, the overall \u0026ldquo;satisfied\u0026rdquo; and \u0026ldquo;very satisfied\u0026rdquo; rate with the retainer among patients in the experimental group reached 11.77% and 82.25%, respectively. Dissatisfactory results also needed to be taken seriously. Two patients reported being \u0026ldquo;strongly dissatisfied\u0026rdquo; with the weight of the retainer, while another 2 patients reported being \u0026ldquo;dissatisfied\u0026rdquo;. One patient reported being \u0026ldquo;strongly dissatisfied\u0026rdquo; with the durability of the retainer, while 3 patients reported being \u0026ldquo;dissatisfied\u0026rdquo;. Regarding wearing comfort, 4 patients reported being \u0026ldquo;strongly dissatisfied\u0026rdquo;, and five patients reported being \u0026ldquo;dissatisfied\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e6\u003c/span\u003e). This reminded us that future improvements to the retainer must focus on using lighter, more flexible, and more comfortable materials to ensure a nearly imperceptible wearing experience. Preoperatively, the Visual Analog Scale (VAS) score for the appearance of the affected ear given by patients in the experimental group (or guardians, similarly hereinafter) was 1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89. The VAS score significantly improved immediately postoperatively to 7.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40 (z = -7.47, P\u0026thinsp;=\u0026thinsp;0.00). At the final follow-up, the VAS score increased to 7.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24, with no statistically significant difference compared to the postoperative score (z = -0.34, P\u0026thinsp;=\u0026thinsp;0.73). The Visual Analog Scale (VAS) score for the appearance of the affected ear given by patients in the control group was 1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04, and significantly improved immediately postoperatively to 7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46 (z = -7.51, P\u0026thinsp;=\u0026thinsp;0.00). At the final follow-up, the VAS score increased to 7.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17, with no statistically significant difference compared to the immediately postoperative score (z = -0.89, P\u0026thinsp;=\u0026thinsp;0.93).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Likert scale for wearing the retainer.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNumber of patients (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStrongly dissatisfied\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eDissatisfied\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNeutral\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSatisfied\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eVery satisfied\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (14.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58 (84.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (17.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50 (72.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjustability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (10.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62 (89.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSafety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68 (98.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDurability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (7.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (13.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 (73.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimplicity of use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (11.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58 (84.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (7.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (11.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49 (71.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (14.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58 (84.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.87 (1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.63 (2.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.63 (2.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.12 (11.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.75 (82.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNon-surgical treatment of cryptotia, such as the use of external corrective devices, is typically suitable for newborns under 6 weeks of age\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. However, due to limited awareness of the condition and other factors, most patients miss the optimal time window for non-surgical intervention. As a result, surgical correction remains the primary treatment for cryptotia. Traditional treatment methods for cryptotia, including Z-plasty, V-Y advancement flaps and skin grafting\u003csup\u003e\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, often address skin deficiency but may fall short in achieving long-term stability due to the elastic recoil of the auricular cartilage. Although plastic surgeons have made numerous efforts to prevent postoperative recurrence of cryptotia\u003csup\u003e\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, recurrence remains a significant challenge in the treatment of this condition\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. This study evaluated the efficacy of personalized 3D-printed retainers in maintaining auricular morphology following corrective surgery for cryptotia.\u003c/p\u003e \u003cp\u003eIn this study, no statistically significant differences were observed between the affected and normal ears in terms of perimeter, width, length, and D value in both the experimental and control groups at the last follow-up, which indicated satisfactory surgical outcomes with no evident tendency for recurrence. The statistical significances observed in differences of relevant auricular indicators between the experimental and control groups highlighted the retainer\u0026rsquo;s pivotal role in stabilizing the auricular morphology after the surgery. The subgroup analysis revealed a notable interaction between the need for free skin grafting and the effectiveness of the retainers. Patients in Subgroup A, who did not require grafting, exhibited better outcomes with the retainers compared to Subgroup B, who underwent free skin grafting. This may be because patients in Subgroup A had their wound covered solely with a retroauricular triangular skin flap during surgery. Postoperatively, factors such as cartilage recoil, and contraction of scar tissue and the skin flap made it more difficult for these patients to maintain a stable auricular morphology, thus rendering the retainer's role in maintaining postoperative morphology more significant for this subgroup. In contrast, patients in Subgroup B underwent free skin grafting during surgery, which reduced tension on the retroauricular incision. Consequently, the effects of scarring and flap contraction on auricular morphology were minimized, making recurrence less likely and the impact of the retainer less pronounced compared to Subgroup A. Patient satisfaction is also a key indicator of the success of reconstructive procedures. In this study, the result of Likert scale indicated an overall satisfaction rate of 82.25% among patients in the experimental group regarding the retainer. Additionally, both the experimental and control groups showed significant improvement in VAS scores from the preoperative assessment to the last follow-up.\u003c/p\u003e \u003cp\u003eAt present, 3D printing has been widely applied in the field of auricular reconstruction, including surgical simulation and practice\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, intraoperative guide plates production\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e, external corrective devices\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e, and the fabrication and transplantation of ear scaffolds\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. However, there are currently no reports on the application of 3D printing for postoperative support and morphology maintenance following auricular corrective surgery\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. By providing anatomically precise, customized devices, our retainer addresses the limitations of traditional postoperative support methods, enhancing the stability of surgical correction, reducing the likelihood of recurrence, and improving patient satisfaction. This method represents a significant advancement in the treatment of auricular deformities. The integration of 3D printing technology into postoperative management offers transformative benefits. Personalized 3D-printed retainers addressed many limitations of traditional supportive devices by providing: (1) Precise Fit and Customization: The retainers were designed based on high-resolution 3D scans of the patient\u0026rsquo;s affected ear, ensuring an exact fit that adapts to individual anatomical variations; (2) Biocompatibility and Comfort: The use of advanced materials such as BioMed Flex 80A resin ensured that the retainers were both durable and comfortable for long-term wear\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e, reducing the risk of irritation or pressure sores; (3) Uniform Quality and Reliability: Stereolithography (SLA) enabled the production of retainers with consistent quality and precision, ensuring reliable performance across patients, and (4) Enhanced Aesthetic Outcomes: The ability to maintain the natural contours of the auricle contributes to improved aesthetic results, which are often a primary concern for patients undergoing corrective surgery.\u003c/p\u003e \u003cp\u003eWhile this study provides compelling evidence of the efficacy of 3D-printed retainers, several limitations must be acknowledged. The single-center design and relatively small sample size may limit the generalizability of the findings. Additionally, all patients included in this study were Asian. Multicenter studies with larger cohorts and patients of different nationalities involved are needed to validate these results and establish broader clinical guidelines. Additionally, the follow-up period, although sufficient to evaluate short-term outcomes, may not capture the long-term effects of the retainers on auricular growth and morphology. Future research should focus on longitudinal studies to assess the durability of the outcomes and the impact of the retainers on the natural growth trajectory of the auricle. Another area for exploration is the integration of advanced materials and technologies into the retainer design. For example, incorporating sensors to monitor pressure distribution or using bioresorbable materials could further enhance the functionality and patient experience.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePersonalized 3D-printed retainers represented a significant advancement in the postoperative management of cryptotia. By providing consistent support and maintaining the corrected auricular morphology, these retainers played a pivotal role in achieving stable, aesthetically satisfactory, and functionally effective outcomes. This study underscored the value of integrating cutting-edge technologies like 3D printing into clinical practice to address complex challenges in auricular reconstruction. The promising results paved the way for future innovations in personalized medicine and highlighted the transformative potential of 3D printing in improving the outcomes of auricular reconstructive surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMr. Zhi and Mr. Wang contributed equally to this article as co-first authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJiajun Zhi and Peixu Wang contributed equally to this study. Haiyue Jiang and Lin Lin participated in the design of the study. Jiajun Zhi and Peixu Wang collected and analyzed the data and wrote the article. Haiyue Jiang and Bo Pan critically revised the article. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article (tables 1-6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures and Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. This study was approved by Institutional Review Board of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten consent forms for the surgery and the use of portrait were obtained from all patients and/or their guardians before the surgery. All patients and/or their guardians voluntarily participated in this study and provided consent for the publication of photographs collected during the study in open-access journals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Chinese Academy of Medical Science Innovation Fund for Medical Sciences (2021-I2M-052), Beijing Municipal Science \u0026amp; Technology Commission (No. Z221100007422084), Young Scientists Fund of the National Natural Science Foundation of China (Grant No. 8230092675), and Beijing Natural Science Foundation (No.7244400).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHo, S., Lee, D. \u0026amp; Yellon, R. Cryptotia. \u003cem\u003eOtolaryngol Head Neck Surg\u003c/em\u003e \u003cstrong\u003e123\u003c/strong\u003e, 339 (2000). https://doi.org/10.1067/mhn.2000.105468\u003c/li\u003e\n\u003cli\u003eKantu, K., Aretsky, P. J. \u0026amp; Polisar, I. A. 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Long-Term Effectiveness of Ear Molding in Infants Using the EarWell Infant Correction System in China. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e \u003cstrong\u003e148\u003c/strong\u003e, 616-623 (2021). https://doi.org/10.1097/prs.0000000000008293\u003c/li\u003e\n\u003cli\u003eXiong, H.\u003cem\u003e et al.\u003c/em\u003e Comparison of 2 Ear Molding Systems for Nonsurgical Management of Newborn Auricular Deformities. \u003cem\u003eEar Nose Throat J\u003c/em\u003e \u003cstrong\u003e100\u003c/strong\u003e, 652s-656s (2021). https://doi.org/10.1177/0145561320901398\u003c/li\u003e\n\u003cli\u003eCho, Y. K., Bae, S. G. \u0026amp; Cho, B. C. Comparison between Z-plasty and V-Y Advancement for the Surgical Correction of Cryptotia. \u003cem\u003eArch Craniofac Surg\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, 7-13 (2014). https://doi.org/10.7181/acfs.2014.15.1.7\u003c/li\u003e\n\u003cli\u003eMarsh, D., Sabbagh, W. \u0026amp; Gault, D. 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Influence of 3D-printing method, resin material, and sterilization on the accuracy of virtually designed surgical implant guides. \u003cem\u003eJ Prosthet Dent\u003c/em\u003e \u003cstrong\u003e128\u003c/strong\u003e, 196-204 (2022). https://doi.org/10.1016/j.prosdent.2020.08.038\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cryptotia, 3D printing, Retainer, Post-surgery support, Recurrence","lastPublishedDoi":"10.21203/rs.3.rs-5638917/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5638917/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCryptotia, a congenital auricular deformity, presents both aesthetic and functional challenges. This study evaluates the efficacy of personalized 3D-printed retainers in maintaining auricular morphology following corrective surgery for cryptotia. A total of 69 patients with unilateral cryptotia were enrolled in this single-center retrospective cohort study. All patients underwent corrective surgery, and postoperative management included the use of retainers in the experimental group, while the control group did not use any supportive devices. The effect of surgery and retainers relied on the measurement and analysis of auricular indicators preoperatively, immediately postoperatively, and at the last follow-up. Patient satisfaction was assessed using the Likert scale and Visual Analog Scale. Significant improvements in auricular indicators were observed postoperatively in both groups. At the last follow-up, no statistical significances were observed in the differences of key indicators between the affected and normal ears in the experimental group, whereas significant differences were observed in the control group. The experimental group demonstrated a significantly high satisfaction rate (82.25%). Subgroup analysis revealed that the retainers were particularly effective in patients without the need for free skin grafting. This study highlighted the personalized 3D-printed retainers in maintaining auricular morphology and reducing the recurrence after corrective surgery for cryptotia.\u003c/p\u003e","manuscriptTitle":"Personalized 3D-Printed Retainers as A Novel Approach to Maintain the Auricular Morphology After Corrective Surgery for Cryptotia: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-28 19:37:25","doi":"10.21203/rs.3.rs-5638917/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-06T03:15:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-04T15:16:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-01T04:34:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-21T16:23:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62823675123438549933739641534725434337","date":"2025-04-21T15:07:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-20T01:21:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72487605879008570584249010957506768874","date":"2025-04-20T01:13:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148988949418920485576648642706697237491","date":"2025-04-19T23:00:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226065252693051126154351336697420245724","date":"2025-04-19T22:59:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-19T22:54:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-19T07:24:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-06T15:13:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"347d92b5-3330-4836-8486-b6cf476f7533","owner":[],"postedDate":"April 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":47460009,"name":"Health sciences/Diseases"},{"id":47460010,"name":"Health sciences/Medical research"},{"id":47460011,"name":"Physical sciences/Materials science"}],"tags":[],"updatedAt":"2025-06-02T16:02:54+00:00","versionOfRecord":{"articleIdentity":"rs-5638917","link":"https://doi.org/10.1038/s41598-025-03744-8","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-29 15:57:44","publishedOnDateReadable":"May 29th, 2025"},"versionCreatedAt":"2025-04-28 19:37:25","video":"","vorDoi":"10.1038/s41598-025-03744-8","vorDoiUrl":"https://doi.org/10.1038/s41598-025-03744-8","workflowStages":[]},"version":"v1","identity":"rs-5638917","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5638917","identity":"rs-5638917","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}