title: The application of computer-enhanced imaging to improve preoperative counselling and informed consent in children considering bone anchored auricular prosthesis surgery.
abstract: OBJECTIVE
  Bone anchored auricular prostheses have become a valuable option in the treatment of congenital and acquired deformities of the pinna. However, preoperative counselling and informed consent remains a challenging issue. Until recently it has been difficult to provide the child with a realistic prediction of their own postoperative appearance. This is particularly relevant when a remnant pinna needs to be excised prior to the second stage. The potential for psychological repercussions and the possibility that remnant excision might compromise future autologous tissue reconstruction make it imperative that the decision to proceed with surgery is founded on the best possible information.
  
  
  METHODS
  The authors describe the use of computer enhanced images using the Adobe Photoshop (Apple Mac. Inc.) software package to provide such a preview. This technique is used in the outpatient clinic as an adjunct to counselling provided by clinic staff and is reinforced by meeting children who have already enrolled on to the implant programme. Children are encouraged to follow the stages of their planned operation on the computer screen, providing an accurate insight into the physical consequences of surgery.
  
  
  RESULTS
  Our experiences suggest that this approach has encouraged a better qualitative understanding of implant surgery which has helped to foster the on-going commitment that is required to maintain a long-lasting, trouble-free implant site.
  
  
  CONCLUSIONS
  This application of the Adobe Photoshop package has strengthened our basis for a personal informed consent and has provided an opportunity to lessen the adverse psychological consequences of such irreversible surgery. It is commended for its simplicity as it employs established software to enhance photographic prints or slides taken from the child's clinical records.
authors.affiliation: Department of Paediatric Otolaryngology, The Royal Manchester Children's Hospital, Pendlebury, UK. dp_morris@yahoo.co.uk
authors.forename: D P
authors.initials: DP
authors.lastname: Morris
authors.forename: M P
authors.initials: MP
authors.lastname: Rothera
mesh_terms: D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery*; D003376:Counseling / Q000379:methods*; D004431:Ear, External / Q000002:abnormalities* / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007258:Informed Consent; D008297:Male; D011300:Preoperative Care / Q000379:methods; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods; D012680:Sensitivity and Specificity