[Surgical Therapy of Slipping Rib Syndrome].

We have operated on two cases of slipped ribs syndrome( SRS). Both patients were men in their 40s with a history of right thoracic trauma who were referred to us because of unexplained lower thoracic pain. The left rib was positive for hooking maneuver (lift test), and dynamic ultrasonography showed narrowing of the intercostal space, which led to the diagnosis of SRS. in the first case, the tip of the ninth rib cartilage was excised, and the ninth and tenth rib cartilages were sutured and fixed with No.2 fiber wire in two places with Z sutures. In the second case, the tip of the ninth rib cartilage was excised, the eighth and ninth ribs and the ninth and tenth ribs were fixed with No.2 fiber wire with Z sutures as in the first case, and a 0.7 mm thick poly-L-lactide (PLLA) plate was added between the eighth and tenth rib cartilages. In both cases, the postoperative course was good and the pain disappeared. SRS should be recognized as a disease and surgical treatment should be used as therapy.

Comparing the Analgesic Effects Between the Pre- and Post-costal Cartilage Harvest Cohorts Using Ultrasound-Guided Deep Serratus Anterior Plane Block in Children with Microtia Undergoing Auricular Reconstruction: A Randomized Clinical Trial.

PURPOSE: Pain following costal cartilage harvest surgery is the most common complaint of auricular reconstruction (AR). Anesthesiologists are continuously searching for an effective postoperative pain control method. METHODS: This study was conducted from 10 April 2022 to 10 June 2022. Sixty children undergoing AR using costal cartilage were randomly assigned to either a serratus anterior plane block performed before costal cartilage harvest (SAPB-pre-cohort; n = 30) or the SAPB-post-cohort (Post-costal cartilage Harvest Cohort: n = 30). The primary endpoint measures were the Numerical Rating Scale (NRS) scores of the chest and ear pain degrees recorded at 1-, 6-, 12-, 24-, and 48-h after surgery. Intraoperative anesthetic and analgesic dosages, sufentanil consumption and rescue analgesia consumption during the first 24 h post-operation, cough score during extubation, extubation agitation score, length of stay, the extubation time, first ambulatory time, analgesia duration, and opioid-related adverse effects and SAPB-related adverse effects were the secondary endpoints. RESULTS: The rest and coughing NRS scores were significantly reduced in the SAPB-pre-cohort 6 and 12 h post-operation in comparison with the SAPB-post-cohort (rest 6 h p = 0.002, others p < 0.001). No significant difference in the NRS ear scores existed between the two cohorts (p > 0.05). The use of propofol and remifentanil for general anesthesia during the SAPB-pre-procedure was significantly reduced compared to the SAPB-post-group, with statistical significance (p < 0.001). Sufentanil consumption and rescue analgesia consumption were significantly reduced in the SAPB-pre-cohort (p = 0.001, p = 0.033). The extubation time and first ambulatory time were markedly shorter in the SAPB-pre-cohort (all p < 0.001). Analgesia duration was markedly longer in the SAPB-pre-cohort (p < 0.001). No significant differences were noted in the cough score during extubation, extubation agitation score, length of stay between the two cohorts (all p > 0.05). Opioid-related adverse effects occurred more in the SAPB-post-cohort, while there was no statistical significance (16.7 vs. 36.7%; p = 0.082). There were no blockade-related complications observed in either cohort. CONCLUSION: The analgesic effect of the SAPB-pre-cohort was better than the SAPB-post-cohort suggesting both efficacy and feasibility of preemptive analgesia. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Single Center Description of Adult and Pediatric Endoscopic Posterior Costal Cartilage Grafting.

OBJECTIVE: Posterior glottis impairment alters breathing, voicing, and swallowing. Bilateral vocal fold movement impairment (BVFMI) occurs when the vocal cords are fixed/remain midline. Studies inadequately assessed endoscopic posterior costal cartilage grafting (enPCCG) for BVFMI across broad ages. We aim to assess decannulation and prosthesis free airway in children and adults who have undergone enPCCG. STUDY DESIGN: Retrospective cohort. SETTING: Referral center. METHODS: This study included adults and children who received enPCCG for BVFMI (2010-2018) and were followed for 35 months on average. The main outcome was successful decannulation of patients, or airway improvement in those without tracheostomy. Data on comorbidities, surgical complications, and interventions following surgery were collected. RESULTS: Ten children and 11 adults underwent enPCCG for BVFMI. Eighty-one percent of patients had a tracheostomy at surgery; adults were more likely to have a tracheostomy at surgery (P = 0.035), and to undergo double-staged procedure (P = 0.035) and stent (P = 0.008). Average stent duration was 29.7 days. Overall decannulation rate was 76% (90% for children; 70% for adults). Children were more likely to receive postoperative intensive care unit care (P = 0.004). Adults had mean 4.4 post-enPCCG interventions per patient compared to children's mean 3.91 interventions. The most common interventions were steroid injection (17.6%) and balloon dilation (16%). Preliminary analysis suggests postoperative dysphonia was reported in 66.7% of patients; postoperative dysphagia was rare. CONCLUSION: EnPCCG was more successful at achieving decannulation in children. Adults required additional interventions. A double-staged operation with prolonged stenting is recommended for adult patients. A majority of patients were decannulated at last follow-up.

Autologous Costal Chondral/Osteochondral Transplantation and Costa-Derived Chondrocyte Implantation for Articular Cartilage Repair: Basic Science and Clinical Applications.

There has been increasing application of autologous costal chondral/osteochondral transplantation (ACCT/ACOT) and costa-derived chondrocyte implantation (ACCI) for articular cartilage repair over the past three decades. This review presents the major evidence on the properties of costal cartilage and bone and their qualifications as grafts for articular cartilage repair, the major clinical applications, and the risks and strategies for costal chondral/osteochondral graft(s) harvest. First, costal cartilage has many specific properties that help restore the articular surface. Costa, which can provide abundant cartilage and cylindrical corticocancellous bone, preserves permanent chondrocyte and is the largest source of hyaline cartilage. Second, in the past three decades, autologous costal cartilage-derived grafts, including cartilage, osteochondral graft(s), and chondrocyte, have expanded their indications in trauma and orthopaedic therapy from small to large joints, from the upper to lower limbs, and from non-weight-bearing to weight-bearing joints. Third, the rate of donor-site complications of ACCT or ACOT is low, acceptable, and controllable, and some skills and accumulated experience can help reduce the risks of ACCT and ACOT. Costal cartilage-derived autografting is a promising technique and could be an ideal option for articular chondral lesions with or without subchondral cysts. More high-quality clinical studies are urgently needed to help us further understand the clinical value of such technologies.

Lateral Margin Graft for Minimizing Visible Lateral Margin on Radix Using Autologous Rib Cartilage in Asian Rhinoplasty.

BACKGROUND: Visible lateral margin (VLM) after rhinoplasty is considered one of the potential complications. PURPOSE: The purpose is to assess the suitability of implementing a lateral margin graft (LMG) to mitigate the occurrence of a VLM during augmentation rhinoplasty with autologous rib cartilage. STUDY DESIGN, SETTING, SAMPLE: This is a retrospective cohort study between January 2016 and April 2022 in a private clinic. The inclusion criteria were patients who underwent augmentation rhinoplasty for esthetic purposes using autologous rib cartilage. Patients who received allogenic tissue grafts or alloplastic materials, those with systemic diseases, and pregnant or breastfeeding females were excluded. PREDICTOR VARIABLE: The primary predictor variable is the implementation or nonimplementation of an LMG. MAIN OUTCOME VARIABLES: The primary outcome variable is the esthetic satisfaction and the degree of minimization of the VLM when LMG is implemented and when it is not. Therefore, to understand the esthetic satisfaction, the author used the Rhinoplasty Outcome Evaluation (ROE) questionnaire, and to understand the degree of minimization of the VLM, the author measured the lateral margin visibility score (LMVS) using a 5-point Likert scale score. COVARIATES: The evaluated covariates included sex, age at surgery, number of previous rhinoplasties, purpose of surgery, and postoperative complications. ANALYSES: The data were analyzed using the independent sample t test, paired t test, one-way analysis of variance test. A significance level of P < .05 was employed for all statistical analyses. RESULTS: A total of 69 consecutive patients were included in the study, divided into groups 1 (21 patients without LMG) and 2 (48 patients with LMG). Postoperative ROE scores increased by 15.31 ± 4.03 in group 1 and 22.60 ± 6.77 in group 2 compared to preoperative ROE scores (P < .001). In the patients' LMVS, group 1 had a score of 2.48 ± 0.81, while group 2 had a score of 3.06 ± 0.76 points (P = .009). In the surgeons' LMVS, surgeon 1 indicated scores of 2.38 ± 0.74 and 2.94 ± 0.89 points, respectively (P = .007). Furthermore, surgeon 2 indicated scores of 2.28 ± 0.72 and 2.90 ± 0.83 points, respectively (P = .002). CONCLUSION AND RELEVANCE: When performing rhinoplasty using autologous rib cartilage, the use of an LMG can minimize the VLM, which increases patient satisfaction and surgical completeness.

Application of 3D printing in ear reconstruction with autogenous costal cartilage: A systematic review.

PURPOSE: In recent years, 3D printing technology has been employed as a production method that builds materials layer upon layer, providing notable advantages in terms of individual customization and production efficiency. Autologous costal cartilage ear reconstruction has seen substantial changes due to 3D printing technology. In this context, this research evaluated the prospects and applications of 3D printing in ear reconstruction education, preoperative planning and simulation, the production of intraoperative guide plates, and other related areas. METHODOLOGY: All articles eligible for consideration were sourced through a comprehensive search of PubMed, the Cochrane Library, EMBASE, and Web of Science from inception to May 22, 2023. Two reviewers extracted data on the manufacturing process and interventions. The Cochrane risk of bias tool and Newcastle-Ottawa scale were used to assess the quality of the research. Database searching yielded 283 records, of which 24 articles were selected for qualitative analysis. RESULTS: The utilization of 3D printing is becoming increasingly widespread in autogenous costal cartilage ear reconstruction, from education to the application of preoperative design and intraoperative guide plates production, possessing a substantial influence on surgical training, the enhancement of surgical effects, complications reduction, and so forth. CONCLUSION: This study sought to determine the application value and further development potential of 3D printing in autologous costal cartilage ear reconstruction. However, there is a lack of conclusive evidence on its effectiveness when compared to conventional strategies because of the limited number of cohort studies and randomized controlled trials. Simultaneously, the evaluation of the effect lacks objective and quantitative evaluation criteria, with most of them being emotional sentiments and ratings, making it difficult to execute a quantitative synthetic analysis. It is hoped that more large-scale comparative studies will be undertaken, and an objective and standard effect evaluation system will be implemented in the future.

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.

Costal Cartilage Considerations: Novel Use of Handheld Ultrasound Device in Rhinoplasty.

Handheld ultrasound devices can be used in revision rhinoplasty to evaluate the calcification of costal rib cartilage that is to be harvested for grafting. This article provides instructions on how to perform this technique. Laryngoscope, 134:651-653, 2024.

Quantitative Framework Fabrication with Autogenous Costal Cartilage in Microtia Reconstruction.

Hearing improvement is another basic requirement for microtia patients in addition to aesthetic needs. This quantitative framework fabrication method can reduce the learning curve, obtain satisfactory aesthetic results with few complications, and reserve a certain space for future canalplasty. Laryngoscope, 134:148-153, 2024.

Treatment of Progressive Hemifacial Atrophy by Cartilage Graft and Free Adipofascial Flap Combined with Three-Dimensional Planning.

BACKGROUND: Progressive hemifacial atrophy (PHA) is a rare disease characterized by progressive atrophy of skin, soft tissue, muscles, and underlying bone structures. For severe PHA patients with obvious bone deformities, skeletal framework reconstruction is needed in addition to soft-tissue augmentation. The authors propose a new combinatorial surgical method using rib cartilage graft and free adipofascial flap for restoring facial symmetry. To improve the surgical accuracy, preoperative three-dimensional planning and printing was used. METHODS: Twelve patients with severe facial atrophy were included in the authors' study. Three-dimensional facial image analyses were performed preoperatively to quantify the facial asymmetry. Rib cartilages were harvested and sculptured to the appropriate shape created by three-dimensional planning and fixed to the atrophic bone. The circumflex scapular artery-based adipofascial flap was transplanted to repair soft-tissue deficiency. A residual small monitor flap was left with the adipofascial flap. A revision surgery was performed to perfect the repair if the contour was suboptimal 6 months postoperatively. RESULTS: The adipofascial flaps survived in all 12 patients. All patients achieved good healing without complications. At 1 more year after surgery, the rib cartilage was still in position and rarely absorbed. The morphologic and volumetric difference between the affected side and the unaffected side was improved significantly postoperatively. All patients were satisfied with the results, and no more additional operations were required. CONCLUSION: The combinatorial surgery of rib cartilage graft and free adipofascial flap in the setting of three-dimensional planning and printing can be a good choice in restoring facial symmetry in severe cases of PHA. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Structural Approach to Secondary Repair of the Unilateral Cleft Lip Nasal Deformity.

SUMMARY: Management of the unilateral cleft lip nasal deformity is complex because of the underlying significant asymmetry of the lower lateral cartilages and soft tissues of the nasal base. Suturing and grafting techniques may leave the patient with residual asymmetries of the nasal tip and nostrils. Some of this residual asymmetry may be attributable in part to the anchoring effect of the vestibular skin attachments to the lower lateral cartilages. This article discusses the use of lateral crural release, repositioning, and support with lateral crural strut grafts to manage the nasal tip. The technique involves freeing the vestibular skin from the undersurface of the lateral crura and domes and placement of lateral crural strut grafts with or without amputation of the ipsilateral dome and lateral crura to allow precise resuturing to the caudal septal extension graft. This technique is coupled with the use of a caudal septal extension graft to stabilize the nasal base and provide a strong foundation for the repair. Treatment of the nasal base may require skeletal augmentation to aid in creating symmetry of the alar insertions. Costal cartilage is needed in most cases to provide adequate structural support. Nuances in technique are discussed to help maximize outcomes.

The Efficacy of Intercostal Nerve Block in the Management of Postoperative Pain After Costal Cartilage Harvest for Craniofacial Reconstruction Systematic Review and Meta-analysis.

INTRODUCTION: Autologous costal cartilage harvest is a common procedure in craniofacial reconstruction due to its stability, dependability, and diversity. However, such a procedure is associated with severe donor-site pain postoperatively. Therefore, we aim through this study to compare the efficacy of intercostal nerve block in the management of postoperative pain in patients undergoing costal cartilage harvest for craniofacial reconstruction. METHOD: This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without time-limitation. RESULTS: As a result of reviewing the literature, 33 articles were screened by full-text resulting in 14 articles which met our inclusion/exclusion criteria. However, only four high-quality RCT articles were included in the quantitative synthesis (meta-analysis). The findings of this study suggest that there is no significant difference in pain scores between ICNB and control groups at 12, 24, and 48 h postoperatively, both at rest and with coughing. Therefore, both techniques are considered safe and effective. CONCLUSION: Our results show evidence of favorable outcome of preventive donor-site analgesia with ICNB for harvesting autologous costal cartilage in multiple studies. However, the overall outcomes were insignificant between the two arms. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Comparing the Effectiveness of Betamethasone and Triamcinolone Acetonide in Multimodal Cocktail Intercostal Injection for Chest Pain After Harvesting Costal Cartilage: A Prospective, Double-Blind, Randomized Controlled Study.

BACKGROUND: There has been no previous study on the availability of different glucocorticoid varieties used in the multimodal cocktail for harvesting autologous costal cartilage. This randomized controlled trial (RCT) was to compare the significance and complications of betamethasone and triamcinolone acetonide as a component of the cocktail for harvesting costal cartilage in patients. MATERIALS AND METHODS: The patients were randomized to two groups. The group A used multimodal cocktail: ropivacaine, parecoxib sodium, epinephrine, and triamcinolone acetonide; group B used multimodal cocktail: ropivacaine, parecoxib sodium, epinephrine, and betamethasone. The primary outcomes were chest pain after surgery evaluated with a visual analog scale (VAS). The secondary outcomes evaluated the quality of recovery. The tertiary outcomes included rescue analgesic consumption, the first feeding time and the time to the first ambulation, and duration of hospital stay. RESULTS: The VAS scores between the two groups was not considered clinically significant, but the groups achieved a VAS score of 3 or less. However, the time until the first rescue analgesia and the number were significantly longer and smaller for group A. Additionally, there were no significant differences between the two groups in the duration of hospital stay, first feeding time, the quality of recovery, and the first ambulation time. CONCLUSION: Adding corticosteroids into the multimodal cocktails could improve pain relief after costal cartilage harvest. And the efficacy of Triamcinolone acetonide was better than betamethasone. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hardware failure for anterior chest wall and costal cartilage injuries: A single-center experience.

BACKGROUND: Often missed in blunt chest wall injury, costal cartilage injuries can cause chest wall instability, refractory pain, and deformity. Notably, there is only a small amount of evidence regarding hardware performance when applied to costal cartilage. In a prior multicenter study, hardware failure rate was found to be approximately 3% following surgical stabilization of rib fractures (SSRFs) for all fracture locations. The aim of the current study was to evaluate hardware performance for costal cartilage injuries. METHODS: All patients undergoing SSRF performed at our institution from 2016 to 2022 were queried, including both acute and chronic injuries. Both radiographic and clinical follow-up were retrospectively reviewed to evaluate for hardware failure defined as plate fracture, malposition, or screw migration following cartilage fixation. RESULTS: After screening 359 patients, 43 were included for analysis. Mean age was 64 years, and 67% of patients were male. Median number of fractures per patient was 7 with 60% of patients sustaining a flail chest injury pattern. Median total plates per operation was 6 and median costal cartilage plates was 3. In total, 144 plates were applied to the costal cartilage for the group. Mean follow-up was as follows: clinical 88 days, two-view plain radiography 164 days, and chest computed tomography 184 days. Hardware failure was observed in 3 of 144 plates (2.1%), in three separate patients. Two cases were asymptomatic and did not require intervention. One patient required revisional operation in the acute setting. CONCLUSION: In our institution, hardware failure for costal cartilage fractures was observed to be 2.1%. This aligns with prior reports of hardware failure during SSRF for all injury locations. Surgical stabilization of anterior and cartilaginous chest wall injury with appropriate plate contouring and fixation technique appears to provide adequate stabilization with a relatively low rate of hardware malfunction. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level V.

Comparison of Clinical Results of Crescent-Shaped Expanded Polytetrafluoroethylene (e-PTFE) and Granulated Rib Cartilage for Filling The Nasal Base to correct Midface Depressions.

Objective: The center of the face plays an important role in the fullness of our facial contours, however, sunken center of the face is more common in Asians than in Europeans and Americans. Expanded polytetrafluoroethylene (PTFE) and rib cartilage are commonly used to fill the nasal base to improve the hollowing of the center of the face. This study aimed to compare the efficacy and safety of crescent-shaped expanded polytetrafluoroethylene (e-PTFE) with granulated rib cartilage for nasal base filling to treat midface depressions. Methods: Fifty-one patients with mild to moderate midface depression and normal occlusion admitted to our department from June 2017 to August 2020 were selected. Comprehensive rhinoplasty was performed, which included nasal base filling using crescentic e-PTFE or granulated rib cartilage. They are all women, with an average age of 27.4 years. The e-PTFE group (group A) had 27 cases, while the granulated rib cartilage group (group B) had 24. Changes in two face parameters, the wing ear line and facial convexity, were measured and recorded based on preoperative and postoperative photographs of the patients and using 3D imaging technology. Postoperative complications and satisfaction were assessed by questionnaires to compare the two surgical approaches' differences, advantages, and disadvantages. Results: Postoperative midface depression improved significantly in 51 patients. Most of the patients who underwent both procedures showed significant improvement in the wing ear line and facial convexity. The 3D imaging has also helped us to more objectively assess the changes in midface concavity. Some patients experienced acute discomfort, such as foreign body sensation and stiffness in the surgical area, for the first three months after nasal base filler surgery. Still, these symptoms resolved on their own within six months. Most patients (92.6% in group A and 91.6% in group B) felt that they had natural facial expressions and were satisfied with the filler results. Conclusion: The use of crescentic e-PTFE and granular rib cartilage to fill the nasal base is easy to operate and has a quick postoperative recovery, allowing for good postoperative results. However, after some of the granular rib cartilage filling treatments, the height of the nasal base was lowered, which may be connected to its limited structural support, ease of displacement, and resorption. Crescentic e-PTFE is superior to granular rib cartilage in terms of both morphology and mechanical support. The crescentic e-PTFE filling method provides rapid postoperative recovery and good shape maintenance, but local stiffness is more pronounced than in the granular rib cartilage group. This may help the plastic surgeon's choice of surgical procedure.

Cog graft, a new septal extension graft for designing nasal tip rotation and projection in rhinoplasty.

BACKGROUND: Adjusting the nasal tip rotation and tip projection according to the patient's face and wishes is a very important stage in rhinoplasty with the use of a cog graft positioning the tip point in the appropriate place is possible by adjusting the nose length, tip projection and tip rotation together. OBJECTIVE: The aim of this study is to facilitate positioning the tip rotation and projection in the appropriate place according to the patient's needs in rhinoplasty with Cog graft. MATERIALS AND METHODS: Cog graft was applied in 32 patients who underwent rhinoplasty. Cog graft was prepared from costal cartilage in 10 patients and from septal cartilage in 22 patients. Cog graft was prepared by shaping the superior edge of the septal extension graft like a gear wheel. It is fixed to provide desired projection to the caudal septum. In the position where rotation and projection are evaluated adequately, the graft is fixed with sutures. They were followed in average 18 months (between 6 and 24 months). RESULTS: Twenty of the patients were primary cases and 12 were revision cases. The targeted rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. CONCLUSIONS: Cog graft is a useful graft with which we can adjust the nose length, projection and rotation appropriately and in a short time with a single graft.

New Strategies for Remnant Ear Treatment in Microtia Reconstruction Based on Morphometric Studies.

OBJECTIVE: Given the lack of specific evaluation indices, it is difficult to determine whether to transpose or abandon remnant ears in lobule-type microtia reconstruction. The authors illuminate referable parameters beneficial for proper treatment of remnant ear in an efficient manner. METHODS: A series of 359 lobule-type microtia patients underwent autogenous costal cartilage auricular reconstruction between 2016 and 2021. Fourteen measuring points and defined distances as well as six ratios of specific distances based on position, plumpness, similarity and the width-to-length ratio of the remnant ear have been described, and relevant tactics for appropriate treatments are introduced. RESULTS: Definite morphometric results contribute to attaining satisfactory contours of reconstructed auricles with harmonious earlobes, which exhibit highly similar dimensions and appearances compared to the contralateral normal ears. CONCLUSION: With the help of the proposed locating points and measuring approaches, the procedure of remnant ear treatment is systematically clarified. This technique ensures operation safety and contributes to the aesthetic contour of the auricle. LEVEL OF EVIDENCE: IV Laryngoscope, 134:2741-2747, 2024.

Efficacy of hyperbaric oxygen after microtia reconstruction using costal cartilage: A retrospective case-control study.

Introduction: Microtia reconstruction with autologous costal cartilage framework grafting is challenging because the three-dimensional structure of the ear is highly complex, and meeting the high aesthetic demands of patients can be difficult. If the skin flap overlying the framework is thinned to achieve a smooth and accentuated outline, a poor blood supply in the thin skin flap may lead to skin necrosis, exposure of the framework, and poor surgical results. Hyperbaric oxygen (HBO2) therapy can promote the healing of complex wounds and flaps. This study sought to determine the effectiveness of HBO2 therapy for the prevention of postoperative complications after framework grafting in microtia reconstruction. Methods: We retrospectively evaluated postoperative complications and compared outcomes in pediatric patients who underwent costal cartilage grafting for microtia reconstruction at our institution between 2011 and 2015, according to whether or not they received postoperative HBO2 therapy. HBO2 therapy was applied once daily for a total of 10 sessions starting on the first postoperative day. Results: During the study period, eight patients received HBO2 therapy after costal cartilage grafting, and 12 did not. There was no significant difference in the incidence of postoperative ulcers. However, the incidence of framework exposure was lower, and the healing time was shorter in patients who received HBO2 therapy than in those who did not. Discussion: HBO2 therapy can be used safely in pediatric patients to reduce postoperative complications and improve the aesthetic outcome of microtia reconstruction. After costal cartilage grafting, HBO2 therapy should be considered as adjuvant therapy.

Development of an epigenetic age predictor for costal cartilage with a simultaneous somatic tissue differentiation system.

Age prediction from DNA has been a topic of interest in recent years due to the promising results obtained when using epigenetic markers. Since DNA methylation gradually changes across the individual's lifetime, prediction models have been developed accordingly for age estimation. The tissue-dependence for this biomarker usually necessitates the development of tissue-specific age prediction models, in this way, multiple models for age inference have been constructed for the most commonly encountered forensic tissues (blood, oral mucosa, semen). The analysis of skeletal remains has also been attempted and prediction models for bone have now been reported. Recently, the VISAGE Enhanced Tool was developed for the simultaneous DNA methylation analysis of 8 age-correlated loci using targeted high-throughput sequencing. It has been shown that this method is compatible with epigenetic age estimation models for blood, buccal cells, and bone. Since when dealing with decomposed cadavers or postmortem samples, cartilage samples are also an important biological source, an age prediction model for cartilage has been generated in the present study based on methylation data collected using the VISAGE Enhanced Tool. In this way, we have developed a forensic cartilage age prediction model using a training set composed of 109 samples (19-74 age range) based on DNA methylation levels from three CpGs in FHL2, TRIM59 and KLF14, using multivariate quantile regression which provides a mean absolute error (MAE) of ± 4.41 years. An independent testing set composed of 72 samples (19-75 age range) was also analyzed and provided an MAE of ± 4.26 years. In addition, we demonstrate that the 8 VISAGE markers, comprising EDARADD, TRIM59, ELOVL2, MIR29B2CHG, PDE4C, ASPA, FHL2 and KLF14, can be used as tissue prediction markers which provide reliable blood, buccal cells, bone, and cartilage differentiation using a developed multinomial logistic regression model. A training set composed of 392 samples (n = 87 blood, n = 86 buccal cells, n = 110 bone and n = 109 cartilage) was used for building the model (correct classifications: 98.72%, sensitivity: 0.988, specificity: 0.996) and validation was performed using a testing set composed of 192 samples (n = 38 blood, n = 36 buccal cells, n = 46 bone and n = 72 cartilage) showing similar predictive success to the training set (correct classifications: 97.4%, sensitivity: 0.968, specificity: 0.991). By developing both a new cartilage age model and a tissue differentiation model, our study significantly expands the use of the VISAGE Enhanced Tool while increasing the amount of DNA methylation-based information obtained from a single sample and a single forensic laboratory analysis. Both models have been placed in the open-access Snipper forensic classification website.