Local Estrogen Treatment For Non-surgical Recontouring Of Auricular Cartilage
Jonathan S. Black, M.D., Ryan Duong, B.S., Wilson Omesiete, M.D., Patrick S. Cottler, Ph.D..
University of Virginia, Charlottesville, VA, USA.
PURPOSE: Ear malformations afflict 5% of the population. Correction can be accomplished through ear splinting early in infancy. However, beyond this time point, splinting is ineffective, leaving a surgical solution. This effect is thought to be due to retained circulating maternal estrogens, increasing hyaluronic acid in fetal cartilage, improving malleability. We evaluated the potential of direct exogenous estrogen application on splinted ears to provide long-term structural changes to achieve non-surgical recontouring of auricular cartilage.
METHODS: Ears of 9 New Zealand rabbits were folded and splinted, and randomly assigned an experimental group (injected estrogen, topical estrogen, and untreated control) (n=6). Treatment ears received injected estrogen twice weekly or topical estrogen daily for 4 weeks. The splints were removed 2 weeks after treatment, and daily photographs were taken to calculate the retained fold angle. Biopsies were also taken for histologic analysis.
RESULTS: Splinting led to similar ear orientation (24°±5°, 26°±17°, and 29°±13°) for injected, topical, and control groups respectively. 5 days post-splinting, ear shapes stabilized, with injected estrogen exhibiting a significantly maintained angle (108°±29°) compared to topical estrogen (166°±7°) and control (173°±3°) (p≤0.05). Auricular cartilage thickness and intracartilaginous hyaluronic acid of estrogen treated ears was also preserved compared to control 3 weeks after ceasing treatment.
CONCLUSION: Results demonstrate the potential positive effect of local estrogen treatment in non-surgical remodeling of mature auricular cartilage. Future work is needed to more fully investigate the molecular mechanisms of estrogen treatment, optimize dose and frequency of treatment and develop a formulation to achieve functional dermal penetration.
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