Modified Valente Technique for Cauliflower Ear: Outcomes in Children at Two-Year Follow-Up : New Surgical Technique for Cauliflower Ear.

BACKGROUND: Cauliflower ear deformity, a common sequela of auricular trauma, presents an esthetic and reconstructive challenge. Existing surgical techniques have limitations, including complexity, donor site morbidity, and variable long-term outcomes. MATERIALS AND METHODS: In this case series, we present a novel and minimally invasive surgical approach for the correction of cauliflower ear deformity that adapts the Valente otoplasty technique; it combines cartilage debulking with helical rim release and Mustardé mattress stitches to restore ear contour and reduce the risk of recurrence. The procedural steps include bielliptic post-auricular skin and soft tissue incision, release of the cartilaginous spring, removal of excess fibrocartilaginous tissue, cartilage reshaping with suture to restore contour, and tissue redistribution to promote adherence of skin to the cartilage framework. RESULTS: Outcomes were evaluated in 7 patients (9 ears) with cauliflower ear deformity, assessing surgical duration, complications, patient satisfaction, and esthetic outcomes at two years after surgery. The mean surgical duration per patient was 52 ± 17 minutes, including 2 bilateral procedures. Follow-up at 24 months showed favorable esthetic outcome in all patients with sustained improvements in auricular contour and symmetry with neither loss of the shape nor recurrence of deformity. Patients reported high satisfaction and improved quality of life, with mean Glasgow Children Benefit Questionnaire scores of 99.3 ± 6.3. CONCLUSIONS: This technique thus demonstrated lasting correction of cauliflower ear with favorable cosmetic outcomes, low risk of complications, and high patient satisfaction. Further investigations and longer-term follow-up are warranted to validate the technique's durability and expand its application to older and more diverse patient populations. LEVEL OF EVIDENCE IV: 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 .

Auricular prostheses attached to osseointegrated implants: multidisciplinary work-up and clinical evaluation.

PURPOSE: Not long after the introduction of osseointegrated implants outside the oral cavity, auricular prostheses are retrained on osseointegrated implants. New insights have been gained with the next-generation percutaneous osseointegrated titanium implants for bone conduction hearing since its introduction in 2010. As a result, the same technology was introduced in the Vistafix® system (VXI implant) to retain auricular prostheses. The aim of this study is to evaluate the surgical procedure, clinical outcome, and satisfaction of the patient of osseointegration-retained auricular prosthesis using VXI implants. MATERIALS AND METHODS: 11 patients who received an auricular prosthesis using VXI implants between December 2012 and November 2017 were evaluated retrospectively. The patient's medical files were reviewed to assess clinical complications and the necessity for revision surgery. The subjective outcome was measured using the Glasgow benefit inventory (GBI). RESULTS: In total, 31 implants were placed in 11 patients. None of these implants were lost nor revision surgery needed. An adverse skin reaction was observed in 13.0% of the implants and in 27.2% of the patients, adequately treated with an antibiotic ointment. The average follow-up time was 2 years and 7 months. The GBI displayed a positive score in every patient. CONCLUSIONS: The VXI implants used are a safe and reliable treatment option for retaining auricular prostheses in patients with an absent auricle. Patients were satisfied with their auricular prosthesis and showed benefit in quality of life. Studies with larger numbers and preferably a prospective character are needed to draw statistically significant conclusions.

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.

Ear Scaffold Reconstruction Using Ultrasonic Aspirator for Cauliflower Ear.

Untreated auricular hematomas from ear trauma can result in an ear deformation known as cauliflower ear, secondary to fibrosis and new cartilage overgrowth. Cauliflower ear reconstruction has traditionally utilized tools such as a drill or a scalpel in order to improve auricular cosmesis. We present a case report utilizing an ultrasonic aspirator to recontour the fibrosed cartilage of a cauliflower ear. The ultrasonic aspirator has advantages over traditional tools in its ability to provide finely controlled bone removal without damage to surrounding soft tissue. The patient in this case report underwent multistage reconstruction using the ultrasonic aspirator with excellent cosmetic result and patient satisfaction.

Mechanisms of ear trauma and reconstructive techniques in 105 consecutive patients.

Acquired auricular deformities may diminish facial esthetics and cause psychological distress. The aim of this article is to provide an overview of the type of injuries and applied reconstructive techniques in a large academic hospital in The Netherlands. A retrospective chart review was conducted for the last 105 patients who underwent auricular reconstruction for an acquired deformity. Data concerning gender, affected side, cause of injury, anatomical region, the previous and further surgeries, type of cartilage, and skin cover used were collected and analyzed. 105 patients were included. Acquired auricular deformities were mainly caused by bite injuries (22 %), traffic accidents (17 %), burns (9.5 %), and post-otoplasty complications (9.5 %). The upper third of the auricle was most often injured (41 %), followed by the entire auricle (19 %). 70 % of cases required reconstruction with costal cartilage. The most common form of cutaneous cover was a postauricular skin flap (40 % of cases). This study gives a complete overview of causes and treatment of acquired auricular deformities. The results are comparable with the results of similar studies found in literature. Bite wounds are the leading cause of acquired auricular injuries. The upper third is most commonly affected. In the largest percentage of reconstructions, costal cartilage and a postauricular flap were used to correct the deformity.

Correction of Lying Ears by Augmentation of the Conchoscaphal Angle.

Lying ears are defined as ears that protrude less from the head, and in frontal view, are characterized by lateral positioning of antihelical contour relative to the helical rim. These aesthetically displeasing ears require correction in accord with the goals of otoplasty stated by McDowell. The authors present a case of lying ears treated by correcting the conchomastoid angle using Z-plasty, resection of posterior auricular muscle, and correction of the conchoscaphal angle by releasing cartilage using 2 full-thickness incisions and grafting of a conchal cartilage spacer. By combining these techniques, the authors efficiently corrected lying ears and produced aesthetically pleasing results.

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.

[Reconstructive otoplasty: differentiated approach to rib cartilage processing and ear framework formation using carving technique]. / Rekonstruktivnaia otoplastika: differentsirovannyi podkhod k vyboru metoda obrabotki autorebernogo khriashcha i formirovaniia karkasa ushnoi rakoviny pri pomoshchi karving-tekhniki.

The aim of the research was to optimize surgical rehabilitation of patients with auricle defects and deformities by the developing of differentiated approach to the choice of reconstructive otoplasty method. The study involved 30 patients with auricle defects and deformities of congenital (20 patients) and acquired (10 patients) etiology. The defects were total in 25 patients and partial in 5 patients. All patients underwent ear reconstruction with rib cartilage using carving technique. Preoperative planning was based in Doppler ultrasound of temporal region vessels, laser Doppler flowmetry, temporal skin ultrasound and 3D ribcage CT. The surgical tactic was selected according to the possibility of mastoid region skin usage or necessity of the temporoparietal fascial flap. The approach proved to be highly efficient as otoplasty outcomes were good in 80% of cases, satisfactory in 10% and unsatisfactory in 10%.

The utility of full-thickness skin grafts (FTSGs) for auricular reconstruction.

BACKGROUND: Full-thickness skin grafts (FTSGs) are a common repair option on the external ear, but there are few large case series examining graft sublocations, dimensions, and outcomes. OBJECTIVE: We sought to report our experience with FTSGs for repair of postsurgical defects of the external ear. METHODS: We conducted a retrospective review of all FTSGs on the ear performed by 2 surgeons (J. C., 2000-2014; B. C. L., 2007-2014) after clearance by Mohs micrographic surgery at a single institution. RESULTS: A total of 1519 FTSGs on the ear were performed between June 2000 and March 2014. The most common sublocations were the superior helix (38.8%), the crura of the antihelix or scapha (18.9%), and the back of ear/back of helix (15.4%). The overall complication rate was 1.6%, and the most common complication was graft failure (1.2%). LIMITATIONS: Data were collected retrospectively from a single institution. Follow-up beyond 3 months was limited. A standardized assessment tool for aesthetic outcomes was not performed. CONCLUSION: By taking advantage of predictable "pincushioning" and combining with local flaps or cartilage grafts, FTSGs can provide more volumetric replacement than previously described. They reliably preserve the height and complex topography of the ear with a low complication rate.

Two-Step Reconstruction of Non-Marginal Auricular Defects.

PURPOSE: Auricular reconstruction is an extensively discussed topic in facial reconstructive surgery and poses an immense challenge to the reconstructive surgeon. This report describes a 2-stage technique to repair non-marginal full-thickness defects of the auricle. MATERIALS AND METHODS: Thirteen patients underwent surgery after partial to complete loss of the auricular concha using an improved and refined method. Tissue from the pre- and retroauricular regions was used to replace nonhelical auricular tissue loss in 2 surgical steps. All procedures were performed in an ambulatory setting using local anesthesia. RESULTS: All 13 patients (age range, 37 to 82 yr; mean age, 68 yr; 4 women and 9 men) had excellent esthetic outcomes with low surgical morbidity and were satisfied with the achieved results. No flap necrosis was observed. Auricular vertical and horizontal dimensions changed minimally (0 to 4 mm). A tension-free closure of the donor-site defects could be achieved primarily. CONCLUSION: The present method uses 2 separate donor sites to reconstruct centrally located full-thickness defects of the auricle. It is straightforward to perform, minimizes the surgical steps required, shows excellent outcomes, and allows easier closure of the donor site because of the distribution of the harvested tissue.

A modified technique for firm elevation of the reconstructed auricle.

Reconstruction of the external ear for microtia remains one of the most challenging clinical problems in reconstructive surgery. Whether the reconstructive effort replicates a normal ear relates to making a delicate ear cartilage framework and achieving a firm projection of the constructed auricle. In this study, we present a new technique to create a firm elevation. 46 patients with congenital microtia, 30 male and 16 female, are included in this series. We used a modified Nagata's two-stage technique. In the second stage, instead of using a temporoparietal fascial flap to wrap a cartilage wedge, we developed a new technique using the retroauricular fascial flap wrapping a porous polyethylene (Medpor) wedge as the strut. None of the patients demonstrated any necrosis for the implanted auricle and grafted skin. None of the patients had postoperative exposure of the porous polyethylene wedge. The height of the protrusion for point 1 (the protrusion at superaurale level) and point 2 (the inferior end of the helix, where it connects with the lobule) ranged from 1.1 to 1.6 cm with the median of 1.23 cm, and from 0.8 to 1.1 cm with the median of 0.93 cm, respectively. The advantages of this technique are safe, practical and straightforward. The retroauricular fascial flap can help to fix the wedge and provide good vascular supply to the grafted skin. The porous polyethylene wedge provides excellent projection for the reconstructed auricle.

Computed tomography-based training model for otoplasty.

Otoplasty for the correction of protruding ears is characterized by various techniques and a common and popular cosmetic procedure. For the surgeon, whether beginner or advanced, it is essential to understand the principles and master techniques for standard auricular deformities before applying further sophisticated methods, because a lot of complications and failures are caused by wrong indication and incorrect surgical techniques. The different surgical steps are best learned from teaching models. Therefore, we developed two different silicone models of protruding ears with moderate auricular deformities: one with conchal hyperplasia for the training of conchal resection, and one without antihelix for creating an antihelical fold by suturing technique, based on computed tomography scans of patients. The silicone ear models were evaluated during four standardized surgery courses for residents in otorhinolaryngology by 91 participants using specially designed questionnaires. Nearly all participants rated the training on the auricular models as very helpful (n = 51) or good (n = 31); the scores for the different techniques and properties of the models ranged from 2.0 to 2.6 in a range from 1 (very good) to 4 (inadequate). The good results demonstrate the possibility for learning different surgical otoplasty techniques with this newly designed teaching tool.

Bone Marrow Stem Cells and Ear Framework Reconstruction.

BACKGROUND: Repair of total human ear loss or congenital lack of ears is one of the challenging issues in plastic and reconstructive surgery. OBJECTIVE: The aim of the present study was 3D reconstruction of the human ear with cadaveric ear cartilages seeded with human mesenchymal stem cells. METHOD: We used cadaveric ear cartilages with preserved perichondrium. The samples were divided into 2 groups: group A (cartilage alone) and group B (cartilage seeded with a mixture of fibrin powder and mesenchymal stem cell [1,000,000 cells/cm] used and implanted in back of 10 athymic rats). After 12 weeks, the cartilages were removed and shape, size, weight, flexibility, and chondrocyte viability were evaluated. P value <0.05 was considered significant. RESULTS: In group A, size and weight of cartilages clearly reduced (P < 0.05) and then shape and flexibility (torsion of cartilages in clockwise and counterclockwise directions) were evaluated, which were found to be significantly reduced (P > 0.05). After staining with hematoxylin and eosin and performing microscopic examination, very few live chondrocytes were found in group A. In group B, size and weight of samples were not changed (P < 0.05); the shape and flexibility of samples were well maintained (P < 0.05) and on performing microscopic examination of cartilage samples, many live chondrocytes were found in cartilage (15-20 chondrocytes in each microscopic field). CONCLUSION: In samples with human stem cell, all variables (size, shape, weight, and flexibility) were significantly maintained and abundant live chondrocytes were found on performing microscopic examination. This method may be used for reconstruction of full defect of auricles in humans.

Clinical Outcomes of Osseointegrated Prosthetic Auricular Reconstruction in Patients With a Compromised Ipsilateral Temporoparietal Fascial Flap.

Patients with major ear deformities and associated compromise of the superficial temporal artery are poor candidates for autogenous ear reconstruction because of a tenuous ipsilateral temporoparietal fascial flap (TPFF). Osseointegrated prosthetic auricular reconstruction (OPAR) is an alternative to contralateral free TPFF microsurgical and autogenous reconstruction, but data on clinical outcomes are limited. The records of patients with ear loss or major deformity and a compromised ipsilateral TPFF who underwent OPAR from 1989 to 2013 were reviewed. Satisfaction was assessed using a questionnaire based on a 5 point Likert scale. Thirty-two patients (8 women, 24 men) with mean age 43.0 years (range, 10-70 years) underwent OPAR. The ipsilateral TPFF was compromised due to major trauma (13 patients), cancer extirpation (9), burn injury (4), previous harvest (4), arteriovenous malformation (1), or infection (1). All but 2 patients had an associated craniofacial defect, such as soft tissue deformity (87.5%), hearing loss (46.9%), or bony deformity (31.3%). The overall implant success rate was 88.6% at mean follow-up time of 7.6 years post-OPAR. Prosthesis wear averaged 12.2 hours/day and 6.6 days/week (80.5 hours/week). All 5 patients who experienced implant failures had received prior head and neck irradiation. With their prosthesis, 76.2% (16 patients) stated that their self-consciousness and self-esteem were "better" or "much better," whereas 85.7% (18 patients) stated that their self-image was "better" or "much better." All patients declared that they would undergo the treatment again. Osseointegrated prosthetic auricular reconstruction is a reliable option in this challenging population with high patient satisfaction. Patients with prior radiotherapy may have a higher chance of implant failure and would benefit from extended annual follow-up.

Repairing a non-marginal full-thickness auricular defect using a reversed flap from the postauricular area.

PURPOSE: Different methods for auricular reconstruction have been introduced over time. To minimize stress on the flap and offer an excellent wound control, the anterior pedicled retroauricular flap (APRF) was described in 2012. It offers an excellent alternative for reconstructing different parts of the ear helix. The authors also apply the APRF to repair centrally located perforating defects of the ear. MATERIALS AND METHODS: The APRF was used to reconstruct nonhelical full-thickness defects of the auricle in 11 patients. The operations were performed under local anesthesia and in an ambulatory setting in 3 operative steps. RESULTS: The repair of full-thickness conchal defects was successfully performed in 11 patients, with good esthetic outcome, minimal donor site morbidity, and high patient satisfaction. CONCLUSION: An APRF from the postauricular area is a simple and effective method to reconstruct a full-thickness non-marginal auricular defect.

Auricular reconstruction after human bite amputation using the Baudet technique.

OBJECTIVE: This study aimed to present a case of a successful re-implantation of an amputated auricle following a human bite using the Baudet technique. METHODS: Case report and review of the literature. RESULTS: The patient had a very satisfactory postoperative result in terms of appearance and function of the reattached auricle. Cartilage loss was minimal. CONCLUSION: Reattachment of an amputated auricle as a composite graft following a traumatic human bite is feasible. The Baudet technique is a simple alternative that avoids the complexity of microsurgical anastomosis while improving upon the high failure rate associated with simple reattachment.

Injury Patterns and Reconstruction in Acquired Ear Deformities.

Reconstruction following ear trauma presents a heterogeneous group of abnormalities with significantly more variation in presentation. The aim of the study was to analyze our experience and expound some broad principles of auricular reconstruction in acquired ear deformities. A total of 117 patients with human, animal bites and revision otoplasty presented to our clinic. Demographic data were extracted from medical records and photographs. Management options included no reconstruction, external silicone prosthesis, or autologous reconstruction. Fifty percent of patients with human bite injuries and 62% with animal bite injuries opted for autologous ear reconstruction. A flap with either a costal cartilage framework (37/39; 95%) or conchal cartilage (2/39; 5%) was used. In revision otoplasty group, 12% required autologous reconstruction either with conchal or costal cartilage. We discuss our indications, techniques, complications, and predictable pattern of injuries in human bites. Autologous auricular reconstruction of traumatic injuries is a safe procedure associated with aesthetically pleasing outcome and improved quality of life despite physical and psychosocial comorbidities. Elderly patients are more likely to opt for prosthetic camouflage.

Trauma Management of the Auricle.

Smaller injuries of the auricle, such as lacerations without tissue loss, have more or less standardized treatment protocols that require thorough wound closure of each affected layer. Even extended lacerations of larger parts of the ear quite often heal with only minor irregularities. New in vivo diagnostic tools have aided the understanding of this outstanding "skin flap behavior." At the other end of the trauma severity spectrum are partial or complete amputations of the ear. Here, the debate has become more intense over the last decade. There were numerous reports of successful microvascular reattachments in the 1990s. Consequently, pocket methods and their variations have received increasing attention because the results seem to be convincing. Nevertheless, the pressure damage due to banking larger parts of the elastic cartilage in the mastoid region is tremendous, and the tissue for secondary reconstruction is severely injured. Particularly in cases of acute trauma with relevant concomitant injuries to the patient and in cases in which the amputated area is in a critical state, direct wound closure is a straightforward and safe option. Subsequent thoughtfully planned secondary reconstruction using ear or rib cartilage, or even allogenous material as an ear framework, can achieve excellent aesthetic results.