Management of recurrent pinna haematoma following rugby injury: a surgical approach.

A young adult male developed a left-sided pinna haematoma after a rugby injury. The haematoma reaccumulated after multiple attempts at drainage under local anaesthetic in emergency rooms and required incision and drainage in the theatre under general anaesthetic. Intraoperatively, multiple venous bleeding points were identified and these were controlled with bipolar diathermy. The wound was closed and dressed with bolster and crepe bandage. On day 7 postoperatively, the sutures and dressings were removed and the haematoma had not recurred. He returned to playing rugby on day 21 postoperatively and sustained another blunt impact to his left ear. He noticed new swelling over the posterior aspect of the same ear. This was drained via needle aspiration and there was no further reaccumulation of the pinna haematoma.

Perioperative position management of 46 cases with simultaneous bilateral auricle reconstruction: A summary of experience.

OBJECTIVES: The primary problem in simultaneous bilateral auricle reconstruction is the fragility of the reconstructed ear structure. Postoperative pressure is strictly prohibited to ensure the operation's effectiveness. The study aimed to summarize the experience of perioperative postural management in simultaneous bilateral auricular reconstruction. METHOD: This study summarizes the experience of perioperative postural management, providing preoperative sleeping posture adaptability training, neck movement training, standardization of the head position angles and the head suspension time in surgery, using protective headrests, paying attention to the transfer and handover procedures, and using specially designed pillows. RESULTS: The comprehensive nursing approach in simultaneous bilateral auricular reconstruction significantly reduced complications, improved patient comfort, and optimized postoperative adaptation. Preoperative posture training, standardized intraoperative head positions, and vigilant postoperative care played pivotal roles, demonstrating positive outcomes in 46 cases. DISCUSSION: Perioperative position management can reduce the risk of complications and pressure injuries, improving patients' postoperative comfort, emotional state, tolerance, and adaptability. CONCLUSION: All ears were viable and in good shape after long-term follow-up. The experiences discussed in this study can be broadly applied to technically mature ear reconstruction teams.

Analysis of the effect and influencing factors of EarWell auricle orthosis in the treatment of congenital auricle deformity in children.

OBJECTIVE: To observe the efficacy of EarWell ear orthosis in treating children with different types of ear deformities. METHODS: We selected 80 children aged <6 weeks with ear deformities (110 ears: 15, 30, 21, 25, and 19 ears with prominent ear, lop ear, cup ear, cryptotia, and helical rim deformity, respectively). Differences in effectiveness rate, treatment time, and incidence of complications among children with different types of auricular deformities were compared. Recurrence rates at 1 and 3 months after the treatment were compared. RESULTS: The overall success rate was 92.73 %, and the treatment effectiveness rate did not differ significantly among the children with different types of auricular malformations (P > 0.05). The correction time of the helical rim deformity was the shortest, and the correction times of the prominent and cup ears were significantly longer than those of the other groups (P < 0.05). The incidence of complications associated with helical rim deformity and lop ear was lower, and the incidence of prominent and cup ear complications was significantly higher than that in the other groups (P < 0.05). The recurrence rate in children with prominent and cup ears was higher at 1 and 3 months after correction, and children with a lop ear and cryptotia showed no recurrence at 1 and 3 months after treatment, which correlated with the correction time, incidence of complications, and recurrence rate (P < 0.05) CONCLUSION: The EarWell auricle orthosis is an effective treatment in children with auricular morphological malformations. Correction time, complication rate, and recurrence rate were related to the malformation type.

[Analysis of risk factors for congenital auriclar deformity and its different types].

Objective:To Explore the clinical characteristics,risk factors,and differences in risk factors for different types of congenital auricular deformities,in order to provide theoretical basis for precise prevention and control of congenital auriclar deformity. Methods:Full-term newborns born in the Second Affiliated Hospital of Zhengzhou University from May 2022 to January 2023 were screened for auricle malformation, general information and data were collected,,and high-risk factors were investigated withself-made questionnaire.Using a case-control study method,newborns with auriclar deformities were selected as the case group and those without auriclar deformities during the same period were selected as the control group.A case-control study was conducted to analyze the incidence rate,high-risk factors,and differences in high-risk factors for different types of auricle deformities. Results:A total of 1 758 newborns （3 516 ears） were included in this study,including 562 newborns（927 ears） with auriclar deformities,the incidence of congenital malformations of the auricle is 26.37%.Among them,289 ears （8.22%） were helical rim deformity,244 ears （6.94%） were lidding/lop ear,166 ears （4.72%） were mixed deformities,131 ears （3.73%） were prominent/cup ear,79 ears （2.25%） were Stahl's ears,16 ears （0.46%） were abnormal conchal crus,and 2 ears （0.06%） were cryptotia.Maternal history of infection in early pregnancy（OR=1.513，95%CI 1.119-2.045）,previous miscarriage history（OR=1.300，95%CI 1.049-1.613）,and abnormal pregnancy（OR=1.278，95%CI 1.032-1.582） are risk factors for congenital auricular malformations.There was no statistically significant difference in the history of infection（χ²=1.877，P=0.391）,previous miscarriage（χ²=4.706，P=0.095）,and abnormal pregnancy（χ²=5.026，P=0.081） among mothers with helical rim deformity,lidding/lop ear,and mixed deformities. Conclusion:The incidence rate of congenital auricle deformity is high, with common malformations such as helical rim deformity, lidding/lop ear,and mixed deformities. Congenital auricular deformity is caused by various factors, the same risk factor has roughly the same impact on different types of morphological abnormalities.

Tunnelised superiorly based preauricular flap and conchal cartilage graft for antihelix reconstruction.

Reconstruction of a full-thickness defect of the auricle's anterior surface represents a challenge for plastic surgeons. This report describes the case of a man in his 70s, who underwent radical excision of a squamous cell carcinoma involving his right antihelix. We adopted an innovative approach for the reconstruction of the antihelix, using a tunnelled preauricular flap reinforced with an ipsilateral concha cartilage graft. The flap's base was de-epithelialised, allowing a single-stage procedure. Three months postoperation, no complications arose, and the scars at the donor site were effectively concealed. The aesthetic result was excellent, thanks to the perfect colour match, symmetry, shape of the auricle and the long-lasting integrity of the antihelical structure.This technique allows for accurate reconstruction of the convoluted surface of the auricle in cases of full-thickness defects of the antihelix, without the need to harvest cartilage from other donor sites and in a single surgical procedure.

Tissue-resident macrophages specifically express Lactotransferrin and Vegfc during ear pinna regeneration in spiny mice.

The details of how macrophages control different healing trajectories (regeneration vs. scar formation) remain poorly defined. Spiny mice (Acomys spp.) can regenerate external ear pinnae tissue, whereas lab mice (Mus musculus) form scar tissue in response to an identical injury. Here, we used this dual species system to dissect macrophage phenotypes between healing modes. We identified secreted factors from activated Acomys macrophages that induce a pro-regenerative phenotype in fibroblasts from both species. Transcriptional profiling of Acomys macrophages and subsequent in vitro tests identified VEGFC, PDGFA, and Lactotransferrin (LTF) as potential pro-regenerative modulators. Examining macrophages in vivo, we found that Acomys-resident macrophages secreted VEGFC and LTF, whereas Mus macrophages do not. Lastly, we demonstrate the requirement for VEGFC during regeneration and find that interrupting lymphangiogenesis delays blastema and new tissue formation. Together, our results demonstrate that cell-autonomous mechanisms govern how macrophages react to the same stimuli to differentially produce factors that facilitate regeneration.

The Auricular Injection Technique: A New Treatment for Lying Ear.

SUMMARY: Lying-ear deformity refers to an auricle that bends backward excessively, is excessively folded against the head, and has a very prominent antihelix. It usually requires experienced surgeons to perform surgical treatment and a prolonged postoperative recovery process. This article proposes a simple and effective hyaluronic acid injection technique that significantly improves the shape of the outer ear and enhances perceived facial aesthetics. Twenty patients underwent treatment with multiple injections. Measure-related parameters were used to evaluate the postoperative effect, and the results were graded using a visual analog scale. Interrater reliability among graders was evaluated using intraclass correlation coefficients. After treatment, no serious complications, such as infection or embolism, occurred. Six months after the procedure, the average auriculocephalic angle increased from 25.11 ± 9.46 to 32.72 ± 8.29 degrees, the average conchoscaphal angle increased from 87.69 ± 9.06 to 95.94 ± 7.11 degrees, and patients' average visual analog scale score increased from 4.40 ± 1.14 to 8.57 ± 0.68. Interrater reliability was fair to good for visual analog scale before injection and 6 months after injection (intraclass correlation coefficients, 0.49 and 0.45, respectively; both P < 0.001). The patients were satisfied with the injection process and results. This injection protocol improved the shape of the outer ear, resulting in excellent postoperative outcomes.

The Ram Graft: Using One Complete Piece of Conchal Cartilage for Nasal Tip Reconstruction in East Asians.

SUMMARY: Adequate nasal tip projection remains a challenge in aesthetic rhinoplasty for East Asians. Various surgical techniques have been developed to reshape the nasal tip using auricular cartilage. In this article, we introduce the new ram graft to increase nasal tip projection by using one complete piece of conchal cartilage. Between 2019 and 2021, 19 patients who underwent nasal tip reconstruction using ram grafts were reviewed in a single hospital. The complication rate, satisfaction rate, and changes in nasolabial angle and nasal proportion were recorded. Nineteen patients with a mean age (± SD) of 28.9 ± 6.1 years underwent nasal tip reconstruction. The mean follow-up time was 15.4 ± 6.6 months. Nasolabial angle increased from 87.4 ± 10.0 degrees to 91.2 ± 10.2 degrees ( P > 0.05). Sixteen of 19 patients (84.2%) were satisfied with their results. The nasal length-to-nasal tip projection-to-dorsal height-to-radix height ratio is 2:0.8:0.62:0.19 preoperatively and 2:0.92:0.77:0.35 postoperatively. Complications including alloplast-related infection (two of 19) and septal extension graft-related decrease of nasal tip projection (one of 19) were recorded. By using one complete piece of conchal cartilage, the ram graft is a simple and effective approach to increase nasal tip projection for East Asians. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Partial Central Anterior Reconstruction of the Auricle with One-Stage Combined Retroauricular Flaps.

SUMMARY: Basal cell carcinomas of the central anterior area of the auricle limited to the antihelix and scapha without peripheral infiltration of the helix are not uncommon. Resection is rarely transfixing, but resection of the underlying cartilage is often required. The complex anatomy of the ear and the lack of local tissue available makes its reparation challenging. Defects of antihelix and scapha require special reconstructive techniques, taking into account skin structure and the three-dimensional architecture of the ear. The reconstruction usually consists of full-thickness skin grafting or anterior transposition flap, requiring an extended skin resection. The authors describe a one-stage technique that uses a pedicled retroauricular skin flap turned over the anterior defect, followed by immediate closure of the donor site with a transposition or a bilobed retroauricular skin flap. The one-stage combined retroauricular flap reparation optimizes cosmetic outcome and reduces the risk of successive surgical procedures.

Reconstruction of Concha-Type Microtia Using a Delayed Postauricular Skin Flap.

SUMMARY: Understanding how to remove and retain the relatively large residual auricle is important in concha-type microtia reconstruction. The authors present a method for concha-type microtia reconstruction using a delayed postauricular skin flap. A total of 40 patients with concha-type microtia who underwent ear reconstruction using a delayed postauricular skin flap were retrospectively examined. Reconstruction was performed in three stages. The first stage consisted of preparing a delayed postauricular skin flap and dealing with the residual auricle including removal of the upper residual auricular cartilage. In the second stage, an autogenous rib cartilage framework was placed and covered with a delayed postauricular skin flap, postauricular fascia flap, and autologous medium-thickness skin graft. The ear framework was carefully articulated and secured with the retained residual auricular cartilage to achieve a smooth junction between the two. The third stage involved modification of the reconstructed ear. Patients were followed up for 12 months after ear reconstruction. All reconstructed auricles had a good appearance, and there was a smooth connection between the reconstructed auricle and the residual ear, with similar color as well as a flat and thin scar. All patients were satisfied with the results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Head-related transfer functions of rabbits within the front horizontal plane.

The head-related transfer function (HRTF) describes the direction-dependent acoustic filtering by the head that occurs between a source signal in free-field space and the signal at the tympanic membrane. HRTFs contain information on sound source location via interaural differences of their magnitude or phase spectra and via the shapes of their magnitude spectra. The present study characterized HRTFs for source locations in the front horizontal plane for nine rabbits, which are a species commonly used in studies of the central auditory system. HRTF magnitude spectra shared several features across individuals, including a broad spectral peak at 2.6kHz that increased gain by 12 to 23dB depending on source azimuth; and a notch at 7.6kHz and peak at 9.8kHz visible for most azimuths. Overall, frequencies above 4kHz were amplified for sources ipsilateral to the ear and progressively attenuated for frontal and contralateral azimuths. The slope of the magnitude spectrum between 3 and 5kHz was found to be an unambiguous monaural cue for source azimuths ipsilateral to the ear. Average interaural level difference (ILD) between 5 and 16kHz varied monotonically with azimuth over ±31dB despite a relatively small head size. Interaural time differences (ITDs) at 0.5kHz and 1.5kHz also varied monotonically with azimuth over ±358 µs and ±260 µs, respectively. Remeasurement of HRTFs after pinna removal revealed that the large pinnae of rabbits were responsible for all spectral peaks and notches in magnitude spectra and were the main contribution to high-frequency ILDs (5-16kHz), whereas the rest of the head was the main contribution to ITDs and low-frequency ILDs (0.2-1.5kHz). Lastly, inter-individual differences in magnitude spectra were found to be small enough that deviations of individual HRTFs from an average HRTF were comparable in size to measurement error. Therefore, the average HRTF may be acceptable for use in neural or behavioral studies of rabbits implementing virtual acoustic space when measurement of individualized HRTFs is not possible.

Question Mark Ear: An Unusual Anomaly and a Novel Surgical Technique for Reconstruction.

The question mark ear is a rare abnormality characterized by a cleft between the helix and the earlobe, resulting in a protrusion of the upper part of the ear. The severity of this ear malformation can range from a minor notch in the helix to a complete separation of the helix and the earlobe. In this study, we present a case of a patient with a moderately severe right-sided unilateral question mark deformity. To address this issue, we utilized a novel technique that involves a combination of a Y-V flap with double opposing Z-plasty. Our clinical study demonstrates that using this technique for reconstructing the deformity yields excellent results in terms of the helical rim and fold contour, utilizing solely the local tissues.

Optimal surgical timing for ear reconstruction with autologous cartilage: Analysis of the computed tomography scan characteristics of the ribs.

BACKGROUND: The approach to constructing the cartilage framework for ear reconstruction is sufficiently established. However, there is still no consensus about the age of initiation of surgical treatment. This study aims to assess the development and growth of the costal cartilage to determine the best age to perform ear reconstruction surgery. METHODS: Out of 107 patients, we used presurgical treatment data for 40 patients and medical records for 67 patients aged 5-40. Computed tomography (CT) scans were performed, and average parameters were calculated (length, width, thickness, cartilage density, and standard deviation in Hounsfield units) of the cartilaginous part of the 6th, 7th, 8th, and 9th ribs. RESULTS: The required values were reached at 9-10 years old. CONCLUSION: The criteria for starting surgical treatment in the Russian population was determined by the width of the 6th-7th ribs synchondrosis, which must be equal to the width of a healthy auricle, and the length of the 8th rib should be longer than 9 cm. Therefore, the optimal age for ear reconstruction with autologous costal cartilage is 10 years and older. However, reconstruction can be made earlier in specific cases, according to height and weight and the preoperative CT scan.

Treatment of auricular pseudocysts using enhanced negative drainage: a prospective study of 21 cases.

OBJECTIVE: Auricular pseudocysts are rare, painless, benign intracartilaginous cysts of the auricle that are not lined by epithelium and have no known aetiology. METHOD: This was a prospective study conducted in an ENT department from January 2020 to June 2022. In 21 patients, complete aspiration of the pseudocyst with enhanced negative drainage was performed. They were followed for a minimum of six months. RESULTS: All patients completely responded to the negative drainage treatment. No cases of recurrence or obvious deformities were observed. CONCLUSION: Aspiration with intensified negative drainage was associated with a positive response in patients with auricular pseudocysts. Complete resolution of the swelling can be achieved without any serious complications. Thus, it appears to be a simple and effective method for managing the condition.

[3D printing in plastic surgery, an accessible tool: Technical note around a case of otopoiesis assisted by 3D model]. / L'impression 3D en chirurgie plastique, un outil accessible : note technique autour d'un cas d'otopoïèse assistée par modèle 3D.

3D printing has been used in the medical field since the beginning of the 21st century. Over the years, it has been democratized and has become an accessible tool at almost no cost, provided that a 3D printer is available. The surgeon can thus easily integrate it into his practice and techniques in the operating room, provided that he learns to use 3D image processing software. In order to illustrate the whole process, from the genesis and processing of the 3D image to its application in the operating room, we describe the case of a patient with a left auricle amputation, whose reconstruction was guided by a 3D model printed from his right ear.

Reconstruction of Upper Third Defect of the Auricle by Conchal Cartilage Graft and Coverage by Postauricular Flap.

BACKGROUND: The defects of the upper third of the auricle are considered significant reconstructive challenges, as they require frequent operations with a high risk of morbidity at the donor site and result in unacceptable cosmetic abnormalities. OBJECTIVE: Is to perform the reconstruction of a full-thickness auricular defect located in the upper third of the ear using a conchal cartilage graft with postauricular flap coverage, aiming to minimize both donor and recipient morbidity. PATIENTS AND METHODS: The current study included 20 patients with unilateral upper-third auricular defects. The repair involved 2 components: a cartilage graft from the concha to provide structural support and a flap for coverage. Follow-up was conducted for 6 months after the operation. RESULTS: Successful outcomes were achieved in both subjective and doctors' assessments. Regarding subjective outcomes, 85% of the patients reported high satisfaction (P < .001). In terms of doctors' subjective assessment, 90% of the patients had excellent results (P < .001). Mild early and postoperative complications, if encountered, resolved spontaneously. CONCLUSION: The use of a combined conchal cartilage graft and postauricular flap in treating a full-thickness upper third auricular defect is safe and effective, with no major complications. The technique preserves the cosmetic and functional outcomes of the auricle, providing an excellent color match and minimal donor-site morbidity.