3D evaluation of sagittal inclination of the maxillary dentition in relation to facial landmarks: A cohort study.

BACKGROUND: The determination of the maxillary occlusal plane presents a significant clinical challenge in the treatment of edentulous patients as well as it is critical for complex full-mouth reconstructions in dentate patients, including those with implant-supported rehabilitations. While the use of a Fox plane plate is standard in edentulous cases, its application in dentate patients lacks thorough documentation in existing literature. PURPOSE: This clinical study assessed the sagittal position of the maxillary dentition in relation to facial landmarks using a digital three-dimensional analysis and evaluated the suitability and reliability of applying a simulated Fox plane plate, also known as an occlusal plane guide, in dentate patients. MATERIALS AND METHODS: Eighty-one subjects were recruited at the Department of Prosthetic Dentistry of Goethe University Frankfurt, Germany, according to specific inclusion criteria. Intraoral and facial scans were obtained and analyzed using GOM Inspect Pro software (GOM, Braunschweig, Germany). The angles between the maxillary occlusal plane and three variations each of Camper's plane and ala-tragus line, relating to superior, middle, and inferior tragus points, were measured. These modified planes were then compared to a plane established by a simulated digital Fox plane plate, which was adapted to the maxillary anterior teeth and the lowest point of the posterior teeth in both quadrants. RESULTS: A total of 81 subjects (58 female and 23 male) with a mean age of 23.9 years were evaluated in this study. No significant angular difference was found between the angles of the maxillary occlusal plane compared with superior Camper's plane, middle Camper's plane, or superior ala-tragus line (p >0.05). The smallest angle occurred between superior Camper's plane and the maxillary occlusal plane on both the right (3.443°) and left (3.535°) sides. The application of a Fox plane plate resulted in two different occlusal planes in 70% of patients, significantly deviating from the digitally determined plane (p <0.05). CONCLUSION: Superior and middle Camper's planes, along with superior ala-tragus line, can be considered approximately parallel reference planes and are suitable for routine determining of the maxillary occlusal plane in restorative treatments. However, in contrast to digital evaluation methods, the application of a Fox plane plate in dentate patients showed high variability, indicating its low reproducibility due to its ambiguous positioning on the maxillary dentition. Clinical trial registration site: https://drks.de/search/de/trial/DRKS00030166.

Relocation of polyotia tissue to reconstruct the tragus and fill the preauricular depression.

OBJECTIVES: The present article introduces a lingual composite tissue flap based on the tragus-like structure for correcting polyotia deformity, with the aim of providing a surgical technique that involves relocating polyotia tissue to reconstruct the tragus and fill the preauricular depression. METHODS: The study included a total of 21 patients with polyotia who underwent lingual composite tissue flap reconstruction between January 2020 to December 2022. Patients were retrospectively assessed through a comprehensive review of their medical records and photographic data. Tragus morphology was evaluated based on the measurements of tragus length and width. The Aesthetic Outcomes Scale (AOS), modified Vancouver Scar Scale (mVSS), and Visual Analogue Scale (VAS) were employed for the assessment of surgical outcomes. RESULTS: The follow-up period for all patients ranged from 6 to 15 months. The length and width of the normal tragus were not significantly different from those of the reconstructed tragus. The mean preoperative AOS score was 2.73 ± 0.51, while the mean postoperative AOS score increased to 7.61 ± 0.65. The mVSS yielded an average score of 1.80 ± 1.43, indicating inconspicuous scarring post polyotia surgery. The preoperative VAS satisfaction score was recorded as 1.57 ± 0.67, while the postoperative VAS score significantly increased to 8.33 ± 0.91. The flaps all successfully survived post-operation without any occurrences of flap hematoma, necrosis, infection, or wound dehiscence. CONCLUSION: The reconstruction of the tragus should be given careful consideration when addressing polyotia. The utilization of a lingual composite tissue flap for correction can achieve excellent aesthetic results for the tragus, with high patient satisfaction and minimal complications.

Effect of Low-Level Tragus Stimulation on Cardiac Metabolism in Heart Failure with Preserved Ejection Fraction: A Transcriptomics-Based Analysis.

Abnormal cardiac metabolism precedes and contributes to structural changes in heart failure. Low-level tragus stimulation (LLTS) can attenuate structural remodeling in heart failure with preserved ejection fraction (HFpEF). The role of LLTS on cardiac metabolism is not known. Dahl salt-sensitive rats of 7 weeks of age were randomized into three groups: low salt (0.3% NaCl) diet (control group; n = 6), high salt diet (8% NaCl) with either LLTS (active group; n = 8), or sham stimulation (sham group; n = 5). Both active and sham groups received the high salt diet for 10 weeks with active LLTS or sham stimulation (20 Hz, 2 mA, 0.2 ms) for 30 min daily for the last 4 weeks. At the endpoint, left ventricular tissue was used for RNA sequencing and transcriptomic analysis. The Ingenuity Pathway Analysis tool (IPA) was used to identify canonical metabolic pathways and upstream regulators. Principal component analysis demonstrated overlapping expression of important metabolic genes between the LLTS, and control groups compared to the sham group. Canonical metabolic pathway analysis showed downregulation of the oxidative phosphorylation (Z-score: -4.707, control vs. sham) in HFpEF and LLTS improved the oxidative phosphorylation (Z-score = -2.309, active vs. sham). HFpEF was associated with the abnormalities of metabolic upstream regulators, including PPARGC1α, insulin receptor signaling, PPARα, PPARδ, PPARGC1ß, the fatty acid transporter SLC27A2, and lysine-specific demethylase 5A (KDM5A). LLTS attenuated abnormal insulin receptor and KDM5A signaling. HFpEF is associated with abnormal cardiac metabolism. LLTS, by modulating the functioning of crucial upstream regulators, improves cardiac metabolism and mitochondrial oxidative phosphorylation.

Morphometric Parameters of the Ear and Their Sexual Dimorphism in the Eastern Province of Saudi Arabia.

Background The human ear is a distinctive facial feature, revealing valuable information about ethnicity, gender, and age. Anthropometric measures play a crucial role in fields such as forensic medicine, prosthetics, and plastic surgery. The external ear, known for its diversity in structure and individual characteristics, has become a subject of interest in various populations. This study aims to determine the mean values of morphometric measurements for both right and left ears while exploring sexual dimorphism in ear dimensions. Methodology A prospective, observational, cross-sectional study was conducted among 200 volunteers from the eastern province of Saudi Arabia, comprising 98 males and 102 females, at the Department of Anatomy, Institute of Medical Sciences, Imam Abdulrahman Bin Faisal University. Participants were randomly selected from King Fahad University Hospital workers and patients. Using a Vernier caliper and after obtaining consent, various aspects of ear morphology were measured. The study employed statistical analyses such as the volunteers' t-test, Pearson's coefficient of correlation, and linear regression equations. Results In males, the mean total height of the right and left ears was 6.054 ± 0.5394 and 6.044 ± 0.5235 cm, respectively, while for females, it was 5.489 ± 0.4481 and 5.763 ± 4.8446 cm, respectively. The mean widths, heights, and other dimensions of the ears exhibited variations between genders. Conclusions The study provides comprehensive insights into the dimensions and indices of the pinna among the population of the eastern province of Saudi Arabia. The findings confirmed the presence of sexual dimorphism in the ear measurements, consistent with observations in other ethnic groups.

Positional relationships of the origin and course of zygomaticus major with the nasal ala, tragus, philtrum, and lateral canthus for aesthetic treatments and surgeries.

PURPOSE: The aim of this study was to characterize the origin and course of the zygomaticus major muscle (Zmj) with its topographic relationships with the nasal ala, tragus, philtrum, and lateral canthus. METHODS: The Zmj was examined in 50 specimens of 25 embalmed adult Korean cadavers. Facial muscles were dissected to expose the origin and course of the Zmj in 48 specimens of 24 cadavers. The 25th cadaver was sectioned to obtain images of the Zmj. RESULTS: The positional relationships of the Zmj origin with the nasal ala and the tragus were classified into three categories. A horizontal line through the center of the Zmj origin and the nasal ala passed through the tragus in 20 of 48 specimens (41.7%), the intertragic notch in 18 specimens (37.5%), and above the tragus in 10 specimens (20.8%). In a horizontal section of the head, the Zmj origin was located near the level of the nasal ala and tragus. In a coronal section of the head, the fibers of the Zmj arising at its origin were located close to the zygomatic bone, lateral to the zygomaticus minor muscle. CONCLUSION: By combining dissection with the analysis of sectioned images and ultrasound images of the Zmj, this study has yielded positional information for easily predicting the location of the origin and the course of the Zmj and its related structures underlying the skin.

Noninvasive low-level tragus stimulation attenuates inflammation and oxidative stress in acute heart failure.

PURPOSE: Acute decompensated heart failure (ADHF) is associated with inflammation, oxidative stress, and excess sympathetic drive. It is unknown whether neuromodulation would improve inflammation and oxidative stress in acute heart failure. We, therefore, performed this proof-of-concept study to evaluate the effects of neuromodulation using noninvasive low-level tragus stimulation on inflammation and oxidative stress in ADHF. METHODS: Nineteen patients with ejection fraction < 40% were randomized to neuromodulation 4 h twice daily (6-10 a.m. and 6-10 p.m.) (n = 8) or sham stimulation (n = 11) during hospital admission. All patients received standard-of-care treatment. Blood samples were collected at admission and discharge. Serum cytokines were assayed using standard immunosorbent techniques. Reactive oxygen species inducibility from cultured coronary endothelial cells exposed to patient sera was determined using a dihydrodichlorofluorescein probe test (expressed as fluorescein units). RESULTS: Compared to sham stimulation, neuromodulation was associated with a significant reduction of circulating serum interleukin-6 levels (-78% vs. -9%; p = 0.012). Similarly, neuromodulation led to a reduction of endothelial cell oxidative stress in the neuromodulation group (1363 units to 978 units, p = 0.003) compared to sham stimulation (1146 units to 1083 units, p = 0.094). No significant differences in heart rate, blood pressure, or renal function were noted between the two groups. CONCLUSION: In this proof-of-concept pilot study, in acute decompensated heart failure, neuromodulation was feasible and safe and was associated with a reduction in systemic inflammation and attenuation of coronary endothelial cellular oxidative stress. CLINICAL TRIAL REGISTRATION: NCT02898181.

Transcutaneous electrical vagus nerve stimulation to suppress premature ventricular complexes (TREAT PVC): study protocol for a multi-center, double-blind, randomized controlled trial.

BACKGROUND: The autonomic nervous system can be responsible for the initiation and maintenance of arrhythmias. Low-level tragus stimulation (LLTS), a noninvasive form of autonomic neuromodulation, has been shown to be effective in treating atrial fibrillation. We intended to treat frequent premature ventricular complexes (PVCs) with LLTS. METHODS AND DESIGN: The present study will be a prospective multicenter, double-blind, randomized, controlled trial to assess the antiarrhythmic effects of LLTS on frequent PVCs in patients without structured heart disease (SHD). A total of 100 patients with PVC burden > 10% will be randomly assigned to the active or sham LLTS in 1:1 fashion and receive the proposed intervention for 6 months. The primary outcome is PVC burden at 6 months as assessed by 10 days of continuous ambulatory electrocardiographic monitoring. Secondary outcomes include heart rate variability (HRV), quality of life, skin sympathetic nerve activity, and inflammatory markers. Adverse events will also be recorded. DISCUSSION: The present trial will be the first to evaluate the effect of LLTS on frequent PVCs on patients without SHD. LLTS may serve as a low-cost, minimal-risk, and non-invasive alternative to conventional antiarrhythmic therapy. TRIAL REGISTRATION: ClinicalTrial.gov NCT04909528. Registered on 17 June 2021. World health organization trial registration data set was shown in Supplementary Table 1.

Noninvasive low-level tragus stimulation attenuates inflammation and oxidative stress in acute heart failure.

Purpose: Acute decompensated heart failure is associated with inflammation, oxidative stress, and excess sympathetic drive. It is unknown if neuromodulation would improve inflammation and oxidative stress in acute heart failure. We, therefore, performed this proof-of-concept study to evaluate the effects of neuromodulation using noninvasive low-level Tragus stimulation on inflammation and oxidative stress in ADHF. Methods: 19 patients with ejection fraction < 40% were randomized to neuromodulation- 4 hours twice daily (6 AM-10 AM and 6 PM-10 PM) (n = 8) or sham stimulation (n = 11) during hospital admission. All patients received standard-of-care treatment. Blood samples were collected at admission and discharge. Serum cytokines were assayed using standard immunosorbent techniques. Reactive oxygen species inducibility from cultured coronary endothelial cells exposed to patient sera was determined using dihydrodichlorofluorescein probe test (expressed as fluorescein units). Results: Compared to sham stimulation, neuromodulation was associated with a significant reduction of circulating serum Interleukin-6 levels (-78% vs -9%; p = 0.012). Similarly, neuromodulation led to reduction of endothelial cell oxidative stress, in the neuromodulation group (1363 units to 978 units, p = 0.003) compared to sham stimulation (1146 units to 1083 units, p = 0.094). No significant difference in heart rate, blood pressure or renal function were noted between the two groups. Conclusion: In this proof-of-concept pilot study, in acute systolic heart failure, neuromodulation was feasible and safe and was associated with a reduction in systemic inflammation and attenuation of cellular oxidative stress. Clinical trial: NCT02898181.

Vagus Nerve Stimulation and Inflammation in Cardiovascular Disease: A State-of-the-Art Review.

Vagus nerve stimulation (VNS) has been found to exert anti-inflammatory effects in different clinical settings and has been associated with improvement of clinical outcomes. However, evidence on the mechanistic link between the potential association of inflammatory status with clinical outcomes following VNS is scarce. This review aims to summarize the existing knowledge linking VNS with inflammation and its potential link with major outcomes in cardiovascular diseases, in both preclinical and clinical studies. Existing data show that in the setting of myocardial ischemia and reperfusion, VNS seems to reduce inflammation resulting in reduced infarct size and reduced incidence of ventricular arrhythmias during reperfusion. Furthermore, VNS has a protective role in vascular function following myocardial ischemia and reperfusion. Atrial fibrillation burden has also been reduced by VNS, whereas suppression of inflammation may be a potential mechanism for this effect. In the setting of heart failure, VNS was found to improve systolic function and reverse cardiac remodeling. In summary, existing experimental data show a reduction in inflammatory markers by VNS, which may cause improved clinical outcomes in cardiovascular diseases. However, more data are needed to evaluate the association between the inflammatory status with the clinical outcomes following VNS.

Chronic vagus nerve stimulation in patients with heart failure: challenge or failed translation?

Autonomic imbalance between the sympathetic and parasympathetic nervous systems contributes to the progression of chronic heart failure (HF). Preclinical studies have demonstrated that various neuromodulation strategies may exert beneficial cardioprotective effects in preclinical models of HF. Based on these encouraging experimental data, vagus nerve stimulation (VNS) has been assessed in patients with HF with a reduced ejection fraction. Nevertheless, the main trials conducted thus far have yielded conflicting findings, questioning the clinical efficacy of VNS in this context. This review will therefore focus on the role of the autonomic nervous system in HF pathophysiology and VNS therapy, highlighting the potential reasons behind the discrepancy between preclinical and clinical studies.

Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction.

OBJECTIVES: This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. METHODS: Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. RESULTS: At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. CONCLUSIONS: The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

Transcutaneous vagus nerve stimulation - A brief introduction and overview.

Invasive cervical vagus nerve stimulation (VNS) is approved for the treatment of epilepsies, depression, obesity, and for stroke-rehabilitation. The procedure requires surgery, has side-effects, is expensive and not readily available. Consequently, transcutaneous VNS (tVNS) has been developed 20 years ago as non-invasive, less expensive, and easily applicable alternative. Since the vagus nerve reaches the skin at the outer acoustic canal and ear, and reflex-responses such as the ear-cough-reflex or the auriculo-cardiac reflex have been observed upon auricular stimulation, the ear seems well suited for tVNS. However, several sensory nerves with variable fiber-density and significant overlap innervate the outer ear: the auricular branch of the vagus nerve (ABVN), the auriculotemporal nerve, greater auricular nerve, and to some extent the lesser occipital nerve. VNS requires activation of Aß-fibers which are far less present in the ABVN than the cervical vagus nerve. Thus, optimal stimulation sites and parameters, and tVNS-algorithms need to be further explored. Unravelling central pathways and structures that mediate tVNS-effects is another challenge. tVNS impulses reach the nucleus of the solitary tract and activate the locus-coeruleus-norepinephrine system. However, many more brain areas are activated or deactivated upon VNS, including structures of the central autonomic network and the limbic system. Still, the realm of therapeutic tVNS applications grows rapidly and includes medication-refractory epilepsies, depressive mood disorders, headaches including migraine, pain, heart failure, gastrointestinal inflammatory diseases and many more. tVNS might become a standard tool to enhance autonomic balance and function in various autonomic, neurological, psychiatric, rheumatologic, as well as other diseases.

Transcutaneous vagus nerve stimulation and the realm of its therapeutic hopes and physiologic enigmas.

Vagus nerve stimulation (VNS) is an established treatment option for patients with treatment resistant epilepsy and depression. However, the procedure is invasive and has side-effects. Transcutaneous vagus nerve stimulation (tVNS) is a non-invasive alternative. Particularly transcutaneous stimulation at the outer ear is gaining increasing interest. While the scope of therapeutic tVNS applications is expanding, there are still questions regarding the optimal stimulation parameters and site as well as the physiology and pathways of auricular tVNS. This Special Issue of Autonomic Neuroscience: Basic & Clinical provides an introduction and overview on basic aspects as well as special topics of tVNS.

Non-invasive tragus stimulation improves cardiac post-ischemic remodeling by regulating cardiac parasympathetic activity.

AIMS: Our previous study proved that low-level tragus nerve stimulation (LL-TS) could improve left ventricular remodelling by cardiac down-stream mechanisms. However, the cardiac up-stream mechanisms remain unknown. METHODS AND RESULTS: Twenty-eight adult beagle dogs were randomly divided into an MI group (myocardial infarction was induced by permanent ligation of the left coronary artery, n = 10), an LL-TS group (MI plus intermittent LL-TS treatment, n = 10), and a control group (sham ligation with the same stimulation as the LL-TS group, n = 8). Auricular tragus nerve was bilaterally delivered to the tragus via ear-clips connected to a custom-made stimulator. The voltage slowing sinus rate was used as the threshold to set the LL-TS 80% below this level. At the end of 4 weeks post-MI, LL-TS could significantly increase atrial ganglion plex (GP) activity, decreased left stellate ganglion (LSG) activity, reduced LV dilation, and improved ventricular functions. Chronic intermittent LL-TS treatment significantly attenuated left ventricular remodelling via the up-regulation of α7nAChR expression and the down-regulation of MMP-9 level in post-MI LV tissue. The elevated protein and mRNA of MMP-9 levels in remote areas were significantly ameliorated by LL-TS treatment. CONCLUSIONS: Chronic LL-TS increased GP neural activity and improved ventricular remodelling possibly via α7nAChR/MMP-9 axis.

Cartilage Tympanoplasty: A Review on Its Postoperative Outcomes on Hearing.

Cartilage graft tympanoplasty has a better success rate in the treatment of chronic otitis media if properly prepared pre-operatively and placed intraoperative. To prepare cartilage graft from tragus and to compare pre-operative and postoperative hearing. 35 patients with chronic otitis media of tubotympanic type, without intra/extra cranial complications disease were made to undergo cartilage tympanoplasty. The study was conducted prospectively. In this technique, patients had an average improvement in hearing up to 10-12 dB. The mean post-operative period follow up was 2-6 months. If cartilage graft is properly prepared and placed, cartilage tympanoplasty appears to provide better success rates and hearing results.

A Pedunculated Cervical Mass: A Case Report.

Introduction: A congenital cervical mass is a considerable health problem worldwide; however, accessory tragus (AT) in the neck is extremely rare. The cervical variant of AT or congenital cartilaginous rest of the neck (CCRN) is a rare anomaly related to the branchial arch located at the lateral of the neck that typically presents as an asymptomatic papule or nodule along the anterior border of sternocleidomastoid (SCM) muscle. It is detected since birth or in the first few years of life. Diagnosis is based on the clinical characteristics of the lesion, surgical findings, and histopathologic studies. Case Report: A young man with no underlying diseases or known congenital anomaly was referred by a dermatologist for an asymptomatic pedunculated papule in the left mid-cervical area. Physical examination reveals a firm and mobile papule with a size of 1*1 cm on the anterior middle 1/3 border of the SCM. Radiologic findings illustrated a mass nearby the SCM with a long tract beneath it extending upward. The lesion was finally resected, and during surgery, a long tract was discovered, and histopathologic examination confirmed the diagnosis of a CCRN. Conclusions: Although rare, the cervical variant of AT or CCRN should be considered in a differential diagnosis of benign masses in the neck.

An Evaluation of the Relation Between Variation in Arch Forms and Relative Parallelism of the Occlusal Plane to the Line Joining the Inferior Border of Ala of the Nose With Different Tragal Levels of the Ear in Dentulous Subjects: An In Vivo Study.

Introduction The purpose of this study was to evaluate which of the three positions on the tragus (superior, middle, and inferior), when connected to the inferior border of the ala of the nose, was the most parallel to the natural occlusal plane in dentate patients, to correlate the level of the naturally existing occlusal plane with the ala-tragal line when the tragus was divided into three portions (superior, middle, and inferior), and to determine which position in the tragus occlusal plane is the most parallel. The study also evaluated the correlation between the variation of arch forms and the relative parallelism of the occlusal plane to the ala-tragal line at different tragal levels. Methods This study included 1405 subjects between the ages of 18 and 35 years. A custom-made occlusal plane analyzer was used to check the relative parallelism between the existing occlusal plane and the ala-tragal line when the tragus was divided into the superior, middle, and inferior portions. The Fox plane of the occlusal plane analyzer was placed on the occlusal plane and the paralleling rod was adjusted till parallelism was obtained. The point on the tragus (superior, middle, or inferior) at which parallelism existed was recorded. The study also measured the inter-canine and intermolar distance to find the type of arch form and related it to the position (superior, middle, or inferior) at which the ala tragal line was parallel to the occlusal plane. The assessment was done on both the right and left sides of the subjects. Results Out of the 2810 tragi, the most common location at which parallelism was established was the inferior part of the tragus, which accounted for 47% of the total. Seventy-one percent (71%) of the subjects showed ovoid arch form. When the variation of arch forms was compared to the level of occlusal plane, 46.8% of the subjects with tapered arch form, 54.5% of subjects with square arch form, and 46.0% of subjects with ovoid arch form had the level of the occlusal plane at the inferior portion of the tragus. Conclusion The result of the study indicated that in the majority of the tragi studied, 47% of the subjects had the occlusal plane parallel to a line joining the inferior border of the ala of the nose to the inferior part of the tragus. Irrespective of the arch form, the occlusal plane was found parallel to a line joining the inferior border of the ala of the nose and the inferior part of the tragus. Thus the tragal position did not show any correlation to the variation of arch forms.

Endoscopic type 1 tympanoplasty: comparison of the effects of three different thicknesses grafts.

BACKGROUND: The effects of graft thickness on tympanoplasty is uncertain. OBJECTIVE: To compare the results of endoscopic tympanoplasty using different thicknesses of autologous tissues. METHODS: This retrospective analysis included 186 patients who received type I tympanoplasty, divided into three main groups based of grafting material: perichondrium (A), cartilage-perichondrium (B), or cartilage-perichondrium plus additional perichondrium (C). Group A was subdivided based on whether the placement was inside (A1) or outside (A2) of the malleus. The hearing improvement, graft success rate, and surgery duration were analysed. RESULTS: Statistical analysis showed significant hearing improvement in the three main groups (p < .001); recovery in group A occurred the earliest. Six months postoperatively, group A1 showed significantly greater hearing recovery compared with groups B and C (p < .05). There were no statistical differences the other groups (p > .05) or in the graft success rate among the three main groups (p = .235). The surgery duration of group A was significantly longer than that of groups B and C (p < .001). CONCLUSION AND SIGNIFICANCE: Our results suggest that graft thickness affects hearing recovery; however, graft thickness does not affect the rate of grafting success. Endoscopic transplantation of the perichondrium is more difficult and requires more time.

Tragal remnant flap reconstruction method for congenital tragal malformation in children.

OBJECTIVE: To explore the clinical effect of tragal remnant flap for congenital tragal malformation in children. METHODS: The clinical data of 23 children with congenital tragal malformation hospitalized in our department from May 2017 to May 2021 were retrospectively reviewed. RESULTS: Congenital tragal malformation has various names and clinical manifestations. It is a kind of rare congenital auricle malformation, which can exist alone or in combination with other malformations. About 78.3% of the children with congenital tragal malformation had a natural tragal remnant flap; The rest of the children without tragal remnant flap were repaired by skin flap＆cartilage reconstruction method (SFC-RM). For the depressed deformity around the tragus, the cartilage and fascia tissue around the tragus were used for filling. The overall effect was satisfactory. CONCLUSIONS: Most children with congenital tragal malformation have natural tragal remnant flap. Tragal remnant flap reconstruction method (TRE-RM) not only has shorter operation time, less trauma, faster healing，fewer complications, but also can obtain more natural tragus appearance.