Auricular haematoma an avoidable cosmetic deformity: A chance or negligence.

PURPOSE: This study highlights the importance of immediate intervention needed in cases of auricular trauma cases so as to prevents complications leading to cauliflower ear, loss of cartilage, necrosis. MATERIALS & METHODS: Total 10 cases of primary haematoma & recurrent cases were included in the study. A detailed history was entered in proforma. Procedure was done under local anaesthesia with all aseptic precautions. A cruciate incision was given over the most dependent part of the swelling and flaps were raised. The collection was drained and the under surface of the flap was scraped using Rosen''s knife followed by insertion of small drain tube and pressure dressing was done. Patients were followed up for three months. RESULTS: Out of the 10 cases 6 were primary cases and 4 were recurrent cases out of which males were 80% and females 20%. None of them showed recurrence. Overall cosmetic deformity was negligible with most of the patients. 1 patient developed perichondrial reaction with pain and inflammation which required long course of analgesics and antibiotics. In 3 cases a thickening of the auricle at the site of incision was noticed. CONCLUSION: Auricular haematoma most commonly is seen in male players of contact sports. These patients may land up in emergency department. Thus, by developing collaborative relationships with ENT specialists, emergency department can help ensure that patients experience possible treatment. This will help reduce the cosmetic deformities of pinna which are seen as complication of auricular haematoma.

Optimizing Management of Otophyma: A Case Series Highlighting the Role of Surgical and Retinoid Therapy.

Otophyma is a rare condition that can result in conductive hearing loss. Current otophyma literature does not examine validated treatment outcomes for patients. Utilizing a medical and surgical approach to maintain a patent canal can lead to significant objective improvements. The aim of this case series is to describe a combined successful approach in 3 cases from an academic, multidisciplinary center. The main outcomes analyzed were pre and post air-bone gap audiogram analysis and disimpaction frequency. The results showed that post-management, patient 1 had substantial improvement in hearing, recovering 49 dB in his right ear and 25 dB in his left ear, demonstrating near complete air-bone gap closure. Patient 2 showed a similar dermatologic and functional improvement, although objective audiometric assessment related to otophyma could not be performed due to coexisting chronic otitis media and cholesteatoma. Patient 3, in the 12 months prior to comanagement, had 8 bilateral disimpactions, and following comanagement had 2 disimpactions in 23 months. All 3 patients were pleased with the resultant functional and physical appearance following comanagement. By presenting this approach and objective measures of treatment, we hope to improve future clinical decision-making in a rare condition.

Burned Ear Reconstruction Using a Superficial Temporal Fascia Flap.

OBJECTIVES: Ear deformity caused by burns is one of the most difficult types of deformity to treat with plastic surgery, and the reconstruction of burned ears undoubtedly remains a substantial challenge. This study aims to report the therapeutic regime of using a superficial temporal fascial flap to cover the framework in burned ear reconstruction. METHODS: Autologous costal cartilage was used to form the ear framework in all of the reconstruction cases. A superficial temporal fascial flap was used as soft tissue to cover the ear scaffold. RESULTS: Five patients with 6 ears were included in our study. The external ear healed well and the location, size, and shape of both ears were generally symmetrical. No complication was observed in any of the patients. CONCLUSIONS: The superficial temporal fascial flap is a good choice for covering the autogenous cartilage framework when treating ear deformities after burns.

Tracing the Origins of "Cauliflower Ear" and Its Earlier Names over Two Millenia.

OBJECTIVES: The post-traumatic ear deformity, known today as cauliflower ear, has been described since antiquity. It has long been associated with pugilistic sports (wrestling, boxing) as well as among the mentally ill. The aim of this study is to present the various terms used since antiquity to describe these traumatic deformations of the auricle and to trace the origin of the modern moniker "cauliflower ear." METHODS: Historical study, only based on original documentation accessed through personal libraries and universities repositories, completed with online sources and etymological dictionaries. RESULTS: We were able to identify no fewer than 39 names for the deformity. The term cauliflower ear is of relatively recent origin. It was coined in the first decade of the 20th century, initially in the popular press and subsequently adopted by the medical profession. CONCLUSION: Ironically, the deformity has only superficial resemblance to a cauliflower. The vegetable, which is part of the cabbage family, has a symmetrical and highly ordered fractal geometry with well-circumscribed excrescences. Cauliflower ear, by contrast, notably lacks symmetry and its rounded protuberances flow into one another. Although somewhat a misnomer, the term is deeply rooted in both popular and medical culture. LEVEL OF EVIDENCE: N/A Laryngoscope, 131:E1315-E1321, 2021.

A Prospective Study on Changes in Auricular Protrusion after Chronic Otitis Media Surgery with the Postauricular Approach.

OBJECTIVES: Some patients complain of apparent auricle protrusion after chronic otitis media (COM) surgery with the postauricular approach. This study investigates whether auricular protrusion could be restored to the preoperative state after COM surgery; if so, the time needed after surgery and whether the degree of auricular of protrusion differed according to the surgical procedure. MATERIALS AND METHODS: Forty-seven patients who underwent tympanoplasty and canal wall up and canal wall down mastoidectomy between July 2016 and July 2017 were prospectively studied. To examine the degree of auricular protrusion, the longest distance from the head to the helical rim and the distance from the mastoid process to the helical rim in the plane along the level of the upper margin of the tragus were measured 1 day before surgery and 1 day; 2 weeks; and 1, 2, 4, and 6 months, postoperatively. RESULTS: The superior aspect of the auricle returned to the preoperative state within 2 months of surgery, irrespective of the surgical procedure. The middle aspect was restored to the preoperative state within 4 months of tympanoplasty or canal wall up mastoidectomy, and within 2 months of canal wall down mastoidectomy. CONCLUSION: Postoperative auricular protrusion is a transient phenomenon.

Neck Deformities in Plastic Surgery.

This article provides facial plastic surgeons with the insight to avoid and address common pitfalls in neck procedures. Many aesthetic issues are created from overtreatment or undertreatment of components of the neck. Using the platysma muscle as the divide, ease of access to superficial anatomy leads to overtreatment problems, whereas difficulty of access to deeper structures leads to undertreatment problems and to overall imbalances. Strategies to accurately assess and treat all structures of the neck proportionally can be used to both avoid and treat any neck aesthetic issues. The advent of minimally invasive techniques has resulted in new complications.

Common Complications in Rhytidectomy.

Complications of rhytidectomy are well known, yet often preventable. A thorough preoperative history and physical along with realistic patient expectations provide the surgeon and patient with insight into potential complications and postoperative management. Understanding of surgical pitfalls and avoidance are crucial in beginning to manage facelift complications. Possible complications of facelift techniques should not discourage surgeons from pursuing a particular technique as the majority of complications are temporary. Though, a strong patient-physician relationship is critical when complications occur. Complications may be frustrating for both the patient and surgeon, yet are overwhelmingly temporary and manageable without surgical intervention.

Correction and Prevention of the Pixie Ear Deformity: A Combined Technique.

Background: Ear and earlobe deformities after surgical rhytidectomy are common and can significantly diminish the aesthetic outcome. The main causes of ear/earlobe distortion are skin overresection, an imbalance between vertical/horizontal skin-lift vectors, and tractional distortions through superficial muscularaponeurotic system (SMAS) tension. Objectives: To demonstrate a new method for earlobe suturing and ear fixation that would prevent aesthetics-related complications after facelift surgery. Methods: A total of 105 primary SMAS facelift surgeries were performed between 2015 and 2016 by the first author. A combination technique consisting of a posterior earlobe rotation flap (PERF) and a concha-mastoid suspension suture (CMSS) was executed bilaterally within each facelift procedure (n = 210). A retrospective data analysis was conducted (preoperatively and one year postoperatively) using our hospital information system and a photometric data analysis to assess auricular displacement, earlobe distortion, and hypertrophic scarring. Results: Pseudoptosis of the earlobe was noted in two cases, and auricular displacement was observed in four cases. Bilateral mild hypertrophic scarring was seen in one patient. The postoperative photometric analysis showed a natural ptosis grade I/II in all the patients, with a statistically significantly reduced postoperative earlobe size (P < 0.05). The total rate of aesthetics-related complications was 4% in our cohort (earlobe distortion with pseudoptosis: 1%; auricular displacement: 2%; hypertrophic scarring: 1%). Conclusions: Our modification of the facial flap anchoring at the ear base in combination with a CMSS stabilizes the natural position of the ear and prevents distortion while allowing better control over the earlobe's aesthetic shaping. This novel method reduces the incidence of ear/earlobe deformities and hypertrophic scarring at the ear base after rhytidectomy and, therefore, promises to be a valuable advancement.

Orifice Preserving Double Opposing Z-Plasty for Partial Split Ear Lobe Repair: A Review of 25 Cases.

BACKGROUND: Surgeons often come across split earlobe (SEL) deformities in their clinical practice which usually result from wearing heavy earrings for a long duration. It is of utmost importance to achieve a satisfactory repair with increased strength in one go. OBJECTIVE: To describe a strong repair for partial SEL with preservation of the orifice. MATERIALS AND METHODS: This study is a retrospective review of 25 patients (36 earlobes), who underwent repair of partial SEL deformity with an orifice preserving double opposing Z-plasty in the hospital, from January 2014 to June 2015. The duration of follow-up was 12 months. RESULTS: Adequate cosmetic results were obtained in all patients with no need for revision surgery due to recurrence or scar dehiscence. Patients did not report any difficulty in wearing earrings and were satisfied with the aesthetic outcome. CONCLUSION: The orifice preserving double opposing Z-plasty technique seems to offer an efficacious method of repair of partial SEL deformity with an acceptable scar. The technique is simple and reproducible with good aesthetic outcomes and minimal complications.

Auricular haematoma. / Ørehematom.

Auricular haematomas typically occur as a result of the auricle being pulled or subjected to blunt trauma in association with contact sports, accidents or violence. An auricular haematoma requires prompt surgical intervention to avoid cauliflower ear, also known as «wrestler's ear¼. A cauliflower ear is a permanent deformity made up of connective tissue and cartilage.

Surgical Reconstruction of Traumatic Partial Ear Defects Based on a Novel Classification of Defect Sizes and Surrounding Skin Conditions.

BACKGROUND: Although a standard classification system and corresponding reconstruction methods are well described for microtia, establishing a classification system and corresponding surgical strategies for traumatic ear defects is difficult because the size, shape, and local skin conditions of each defect differ considerably. In this article, the authors describe a useful new classification system and corresponding surgical approaches. METHODS: Ear defects were classified into four types according to defect size and surrounding skin conditions. Defects in which the postauricular skin is of good quality are classified as types I, II, and III. The rest are type IV defects. Four ears (type I defects) were reconstructed using conchal cartilage and posterior auricular flaps. In 51 ears, costal cartilage and posterior auricular flaps were used for single-stage (type II defects, n = 31) or two-stage (type III defects, n = 20) reconstructions. In five instances of severe posterior auricular cutaneous scarring (type IV defects), temporoparietal fascial flaps were created to cover costal cartilage frameworks. RESULTS: Sixty subjects with traumatic partial ear defects were followed for 6 months to 6 years. Most (n = 55) were satisfied with their results. Two patients complained of an unnatural junction between the graft framework and residual ear stump. One was dissatisfied with the reduced ear size, caused by improper fixation and skin flap contraction. Another developed minor framework exposure because of skin necrosis, which healed with conservative management. CONCLUSION: Using our new classification system for partial traumatic ear defects based on defect size and contiguous skin condition, the corresponding surgical repair approach was applied consistently, yielding acceptable results and few complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Pinna abscesses: can we manage them better? A case series and review of the literature.

Suppurative perichondritis of the pinna is a serious condition with potentially long-term cosmetic sequelae. Literature regarding the optimal treatment of these abscesses is scarce with most case series containing low numbers. This work reports the largest series from the UK to date; along with a review of recent literature. A 10-year retrospective review of case notes was undertaken. Demographic data, interventions and microbiology results were recorded along with outpatient descriptions of cosmetic outcomes. 20 patients were identified with male:female ratio of 4:1. Average patient age was 25.3 years (range 8-65). Average duration of symptoms prior to being seen by the ENT department was 9.95 days with an average length of stay in hospital of 2.5 days. 80% of patients had a surgical intervention performed. The commonest organism grown on microbiological culture was pseudomonas (33%). Of patients who attended follow-up, 28.6% had residual deformity. All of these had undergone surgical drainage of the abscess. Residual deformity was associated with longer time before presentation, piercing of the cartilage and a growth of pseudomonas. Prompt surgical management and appropriate antibiotic regimens to cover pseudomonas are the cornerstones of treatment in the event of pinna abscess formation.