Single-stage reconstruction of a large defect of the ear.

To reconstruct a large anterior skin and cartilage defect of the upper half of the external ear in an elderly patient after cancer surgery, different techniques are possible, but single-stage procedures should be advised. Combining flaps with reliable vascular supply, like the revolving door post-auricular flap and a mastoid advancement flap, is an attractive single-stage reconstructive option to rebuild a sturdy auricle.

Borderline Malignant Sebaceoma of the Auricle: A Case Report.

Sebaceoma is a rare benign tumor arising from the sebaceous gland of the skin. Sebaceoma often occurs on the head and neck but rarely on the ears. We present the case of a 78-year-old female patient with a two-year history of a protruding mass in her left ear. Physical examination revealed a well-circumscribed plaque in the crus of the helix of the left ear. A wide local excisional biopsy was taken, and the mass was subjected to histopathologic assessment. While the mass showed cytological findings indicating sebaceoma, it also presented malignant features architecturally and immunohistochemically. Based on these findings, the tumor was regarded as a sebaceoma of borderline malignancy. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03552-4.

HeberFERON en el tratamiento de pacientes con carcinoma basocelular de la oreja / HeberFERON in the treatment of patients with basal cell carcinoma of the ear

Fundamento: El carcinoma basocelular de la región auricular es considerado uno de los más agresivos y con peor pronóstico, suele ser destructivo y mutilante por lo que el tratamiento conservador, como es el uso de los interferones, es importante en la práctica médica habitual. Objetivo: Evaluar los resultados de la aplicación del HeberFERON en una serie de pacientes con carcinoma basocelular en la región auricular. Metodología: Se realizó un estudio observacional, descriptivo y longitudinal en una serie de casos con diagnóstico clínico, dermatoscópico e histopatológico de carcinoma basocelular de la oreja que recibieron tratamiento con HeberFERON en el Policlínico Centro de la ciudad Sancti Spíritus, durante el período del 20 de febrero de 2017 a 20 de diciembre de 2022. En total se incluyeron 29 pacientes. Se realizó una evaluación inicial, durante y 16 semanas después del tratamiento; se les inyectó 10.5 UI de HeberFERON 3 veces por semana perilesional e intradérmico hasta completar 9 dosis. Las variables fueron la respuesta al tratamiento y presencia o no de eventos adversos. Resultados: Predominó el sexo masculino, la localización en la concha de la oreja, subtipo clínico nódulo ulcerativo y el histológico sólido, con respuesta completa en la mayoría de los pacientes. Como eventos adversos más comunes se presentaron dolor en el sitio de inyección, fiebre, edema y eritema perilesional. Conclusiones: La respuesta al tratamiento fue favorable en la mayoría de los pacientes y los eventos adversos que se observaron fueron los descritos en la literatura sin cambio en la actitud farmacológica.

Background: Basal cell carcinoma of the auricular region is one of the most aggressive cancers and with the worst prognosis, is usually destructive and mutilating, therefore conservative treatment, such as the use of interferons, is important in routine medical practice. Objective: To evaluate the results of HeberFERON application in a series of patients with basal cell carcinoma in the auricular region. Methodology: An observational, descriptive and longitudinal study was conducted on a series of cases with clinical, dermoscopic and histopathologic diagnosis of basal cell carcinoma of the ear treated with HeberFERON at the Center Polyclinic in Sancti Spíritus city, during the period from February 20, 2017 through December 20, 2022. A total of 29 patients were included in the study. An evaluation was conducted at the start of treatment, during treatment, and 16 weeks after treatment; the patients were treated with 10.5 IU of HeberFERON by perilesional and intradermal injections three times a week until completing nine doses. The variables were the response to the treatment and the presence or absence of any adverse events. Results: The male sex predominated, location in the ear turbinate, clinical subtype ulcerative nodule and solid histologic subtype, with a complete response in the majority of patients. The most common adverse events were injection site pain, fever, edema, and perilesional erythema. Conclusions: The response to treatment was favorable in most patients, and the adverse events observed were those described in the literature, with no change in pharmacologic attitude.

Reconstruction of anterior auricular defect with postauricular island / 中华医学美学美容杂志

Objective:To investigate the clinical effect of postauricular island flap in reconstruction of anterior auricular defect.Methods:Twelve patients with auricular tumors were retrospectively analyzed in the Department of Aesthetic Plastic and Craniofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. After the tumors were completely removed, the skin defects were repaired with retroauricular island flaps, and the clinical results of the flaps were observed.Results:All the twelve postauricular island flaps were survived postoperatively. One of the flaps had the disorder of blood supply. After puncture with the needle, the congestion was drained out and the flap survived finally. During 1 to 2 years' follow-up, all patients were well satisfied with the surgical results.Conclusions:The posterior auricular island flap in reconstruction of anterior auricular defect has the advantages of simple and easy operation, high survival rate, small scar in the donor area and good aesthetic effect, which is worthy of clinical promotion.

Atypical Fibroxanthoma Resected without Auricular Deformity in an Elderly Patient: A Case Study.

Atypical fibroxanthoma (AFX) is a dermal spindle-cell cutaneous malignancy, which is a relatively benign type of skin cancer that occurs in the elderly with sun-damaged skin. This is a case study of a rapidly enlarged left auricular mass lesion in an elderly patient who was diagnosed with AFX based on histopathological and immunohistochemical findings, and then treated by complete excision to prevent recurrence or metastasis. There was no recurrence during the 1-year follow-up. For otolaryngologists or plastic surgeons, recognizing the clinical and pathologic characteristics of AFX is important for accurate diagnosis and treatment.

Effect of continuous shaping and compression in the comprehensive treatment of auricle keloids / 中华医学美学美容杂志

Objective:To observe the effect of continuous shaping and compression in the comprehensive treatment of auricle keloids.Methods:From June 2018 to April 2020, 40 patients with auricular keloids (53 ears) admitted to the Plastic Surgery Department of Henan Provincial People＇s Hospital were divided into surgical injection group (20 cases, 27 ears) and surgical injection compression group (20 cases, 26 ears) according to the treatment method. The patients were followed up for more than 18 months continuously; the clinical efficacy, satisfaction with auricle morphology, and the occurrence of infection and recurrence were observed in the two groups.Results:The effective rate of surgical injection compression group (24 ears, 92.31%) was higher than that of surgical injection group (16 ears, 59.26%), and the difference was statistically significant (χ 2=5.121, P<0.05). The Vancouver scar scale (VSS) scores of the two groups at 6 months and 12 months after treatment were significantly lower than that before treatment, and the VSS score of the surgical injection compression group was lower than that of the surgical injection group, the difference was also statistically significant ( P<0.05). The satisfactory rate of the surgical injection compression group (22 ears, 84.62%) was higher than that of the surgical injection group (13 ears, 48.15%), and the difference was statistically significant (χ 2=4.048, P<0.05). The recurrence rate of the surgical injection compression group was significantly lower than that of the surgical injection group (χ 2=5.779, P<0.05); there was no significant difference in the infection rate between the two groups of patients after treatment (χ 2=0.001, P>0.05). Conclusions:Surgical resection of auricle keloids combined with local injection of corticosteroids and local shaping and compression can significantly improve the clinical efficacy, maintain the shape of the auricle, and the therapeutic effect is satisfactory.

A longitudinal study of changes of congenital auricular deformity regarding self-correction.

This study aimed to investigate the factors associated with congenital auricular deformities and evaluate the long-term frequency of their self-correction. Ninety newborns were enrolled in the study, and data were collected within 2 weeks after birth and at 1 year. The shape of the auricle was classified into seven categories using a digital image. At 2 weeks after birth, several birth-related factors were evaluated in the auricular deformity and normal groups. At 1 year after birth, the images of auricles were compared with the images at birth, and the changes in the auricle shape were investigated. Congenital auricular deformities were observed in 139 out of 180 ears, and the major type noted was helix rim deformity (47 ears), followed by normal ears (41 ears), and cup ears (33 ears). Male sex was found to have a statistically significant association with the occurrence of auricular deformity. In the longitudinal study, among 43 neonates (86 ears) followed-up 12 months later, the self-correction rate was approximately 50%. The normal auricle and prominent ear increased, helix rim deformity and cup ear decreased significantly. The prognosis of deformity varied depending on the type of deformity. Considering the low self-correction rate in the prominent and cup ears, newborns with these deformities might be recommended to undergo management such as auricle molding technique, as required.

Use of facial vein graft with vascularized composite auricular helical rim flap for alar rim defects.

Nasal alar defects lead to facial disfigurement, and nasal ala reconstruction is an important treatment option. The vascularized composite auricular flap based on the superficial temporal artery is an ideal option for a full-thickness nasal alar defect. However, the pedicle length and the discrepancy in artery diameter between the recipient vessel and flap pedicle continue to be major problems for free auricular composite tissue transfer. Considering that the angular artery is occasionally absent and the course of the infraorbital segment of the facial vein is constant, there are often no suitable vessels around the recipient site for anastomoses to the short pedicle of the flap. In the absence of a suitable recipient artery, an infraorbital segment of the facial vein measuring 2.5cm in length was taken as a graft for the anastomosis of the superficial temporal artery and superior labial artery. End-to-end anastomosis was performed easily. The flap was inset to reconstruct the contralateral ala. The facial vein graft for anastomosis of the superficial temporal artery and branch of the facial artery is a reliable and easy method to resolve the problem of a short pedicle and large artery discrepancy for nasal ala reconstruction with a vascularized composite helical rim flap.

Management of an Inappropriately Treated Case of Auricular Hematoma.

Othematoma is a condition in which blood collects beneath the perichondral layer of the pinna. Recurrent auricular hematoma can be a challenging medical problem, with complications resulting in ear deformity, therefore, appropriate management is important. Improper treatment can result in a deformity known as 'cauliflower ear' or 'wrestler's ear.' We report a case of othematoma that was inappropriately treated and present a review of current treatment options.

Dimensions, Function and Applications of the Auricular Muscle in Facial Plastic Surgery.

PURPOSE: To determine the dimensions and function of the auricular muscle and to consider applications of this muscle in facial plastic surgery. METHODS: Nonpreserved fresh frozen human cadaver dissections from the (HOSPITAL-Blinded) Body Donation program were dissected. The length and width of the superior auricular muscle were measured. One surgeon performed all dissections and measurements. RESULTS: A total of seven left and five right hemifaces were studied. The average central height of the superior auricular muscle was 4.7 cm, and an average width was 5.0 cm. There was no significant difference between the average values of the left versus the right hemiface measurements. The muscle originated in the fibers of the galea and temporal fascia and inserted into the conchal cartilage in each specimen. Engaging the muscle in its line of action yielded slight elevation of the forehead and prevented movement of the galea along the vertex of the scalp. CONCLUSIONS: The auricular muscle acts as an occipitofrontalis stabilizer and a weak brow elevator. 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 .

Computer-aided design and manufacturing construction of a pilot guide for a bone-anchored epithesis to replace an absent pinna.

Bone-anchored epitheses have acquired an important role in auricle reconstruction. The purpose of this technical note is to present a fully in-house digital workflow for the design and three-dimensional (3D) printing of an optimal ear epithesis guide. Two hemifacial microsomia patients with grade IV microtia were treated accordingly. The upper dental arch was optically scanned and a cone beam computed tomography scan of the cranium was obtained. The composite and soft tissue models created were exported into 3D sculpting software. The unaffected ear was virtually mirrored onto the affected side and two ideal implant positions were defined in relation to bone thickness, contralateral symmetry, and housing of the retaining bar. A bite wafer was virtually designed on the upper dental arch and connected to the mirrored ear. The pilot guide was 3D-printed and allowed for correct positioning and orientation during surgery. The prosthetic pinna was manufactured in a conventional way. A bar with retaining clips was used to anchor the prosthetic pinna. Clinically satisfactory results were obtained in two grade IV microtia cases. The fully digital workflow presented to design and 3D-print an optimal ear epithesis guide offers a good alternative to the existing techniques.

Skin Cancers of the Auricle: A Retrospective Analysis of 41 Patients.

OBJECTIVE: Skin cancers of the auricle usually present with challenges because of the unique anatomy and topography of the auricle and the behavior of the tumor. The purpose of this study was to evaluate the clinical and histopathological characteristics and the surgical outcomes in patients with skin cancer of the auricle. METHODS: Medical records of patients who underwent surgery for a skin cancer of the auricle at two different tertiary medical centers during 2010 to 2020 were reviewed retrospectively. Sociodemographic data of patients, tumor location and size, histopathological type and subtype, T-stage, recurrence, and reconstructive technique were evaluated. RESULTS: The study included 41 patients with skin cancers of the auricle. Thirty-six (87.8%) were male and five (12.2%) were female; with a male-to-female ratio of 7.2:1. The mean age of the patients was 71.4 (46-92) years. Eighteen (43.9%) tumors were basal cell carcinoma (BCC) and 17 (41.5%) tumors were cutaneous squamous cell carcinoma (cSCC). The most common subunit for tumor location was the helix (n=17, 41.5%). Wedge resection plus primary closure was the most common surgical technique (58.5%). Recurrent disease was detected in five patients (12.1%). CONCLUSION: The frequency of the skin cancers of the auricle was remarkably high in men, and the helix was the most common subunit. Both BCC and cSCC were the most common histopathological types. Poor prognostic factors such as lymph node metastasis, perineural invasion, and recurrence were relatively common in patients with cSCC of the auricle.

[Mature teratoma of the auricle in children: a case report].

The patient, female, 4 months and 8 days years old, was admitted to the hospital due to the left auricle mass. When the child was born, the parent found that there was a soybean-sized mass in the left auricle, without special treatment, and then gradually increased. Examination: A 5 cm×4 cm size tumor was visible above the left auricle. It was soft and flexible. The upper edge of the left auricle was deformed by the compression of the tumor. The external auditory canal was unobstructed, and the skin was smooth without redness or swelling. Auxiliary examination, CT showed: ①Left outer auricle fat-like density mass, CT value 22-147 HU, consider lipoma; ②Both sides of mastoid, middle ear, inner ear HRCT scan showed no abnormalities.

White radish and swine scapular cartilage models for auricular framework carving training.

BACKGROUND: The aim of this study is to develop a two-stage training module using radish and swine scapular cartilage for carving ear cartilage. METHODS: In the first stage, white radish was cut in 3-6 mm thick slices. The ear cartilage framework was carved using a graver and the helix and antihelix were fixed with pins. In the second stage, swine scapular cartilage was obtained. The thickness varied 3-6 mm. The ear cartilage framework was made. And triangular fossa and scaphoid fossa were carved with graver. A curvilinear cartilage for helix was assembled to the framework by pin fixing. Six participants were recruited for an ear reconstruction training workshop and figures of the cartilage framework were provided. Participants were asked answer the pre-workshop questionnaire and post-workshop questionnaire on a Likert scale to rate their satisfaction with the outcome. RESULTS: On the pre-workshop questionnaire, participants indicated that they did not have sufficient knowledge and skill for fabricating the ear cartilage framework (1.5± 0.5 using white radish; 1.3 ± 0.5 using swine scapular cartilage). On the post-workshop questionnaire, participants responded that they had learned useful knowledge from this workshop, reflecting a significant improvement (3.8± 1.0 using white radish; 4.0± 1.1 using swine scapular cartilage). They also indicated that they had become somewhat confident in this skill (4.2± 0.8 using white radish; 4.3± 0.5 using swine scapular cartilage. The participants generally found the workshop satisfactory (practically helpful, 4.7± 0.5; knowledge improved, 4.8± 0.4; satisfied with course, 4.5± 0.5; would recommend to others, 4.8± 0.4). CONCLUSION: This model can be useful for ear reconstruction training for medical personnel.

Correction of microtia with constriction features using a superficial temporal fascial flap combined with a rib cartilage graft.

BACKGROUND: Microtia with constricted features is characterized by a short helical length of variable severity, upper antihelical or scaphal deficiency, and a downfolded upper ear. No consensus has been reached regarding the most appropriate surgical method for this condition. In this study, we aimed to introduce a simple and safe surgical method for the correction or reconstruction of upper helix ear deformities. METHODS: Between February 2011 and June 2014, eight patients with microtia with constricted upper helix ear deformity underwent reconstruction of the ear deformity. The upper ear helical framework was constructed by carving and curving the eighth rib cartilage harvested from the ipsilateral chest wall, covering this cartilage with a superficial temporal fascial flap, and adjusting the skin graft to align with the ear contour. To evaluate their satisfaction, patients were asked to complete a questionnaire regarding ear shape, symmetry, position, color, and overall outcome scored on a 5-point scale at 12 months postoperatively. RESULTS: None of the patients experienced severe complications in the reconstructed ear. The preoperative and postoperative vertical ear length ratios were 0.88 and 1.02, respectively. And the mean patient satisfaction scores for shape, symmetry, position, color, and overall outcome were 4.2, 4.5, 4.7, 4.4, and 4.6 out of 5 points, respectively. All patients expressed a high level of satisfaction at 12 months postoperatively. CONCLUSIONS: Our technique provides a good alternative method for the reconstruction of moderate constricted upper helix ear deformities in patients who meet the surgical indications with satisfactory outcomes and few complications.

Effects of rabbit pinna-derived blastema cells on tendon healing.

OBJECTIVES: Tendon healing is substantially slow and often associated with suboptimal repair. Cell therapy is one of the promising methods to improve tendon repair. Blastema, a population of undifferentiated cells, represents characteristics of pluripotent mesenchymal stem cells and has the potentials to be used in regenerative medicine. The aim of this study was to investigate the use of blastema allotransplantation in rabbit tendon healing. MATERIALS AND METHODS: In this study, one rabbit was used as a blastema donor, and twenty-four rabbits were divided into control and treatment groups. Blastema cells were obtained from ear pinna upon punch hole injury in the donor rabbit. Under general anesthesia, a complete transverse tenotomy was performed on the midsubstance of deep digital flexor tendon followed by suture-repair. In the treatment group, 1 × 106 blastema cells suspended in buffer saline were injected intratendinously at the repair site, while the control group received only the buffer saline. Cast coaptation was maintained for two weeks. Eight weeks after the operation, tendons were harvested, and histopathological, biomechanical, and biochemical assays were performed on samples. RESULTS: Mechanical testing showed a significant increase in ultimate load, energy absorption, stiffness, yield load, stress, and strain in blastema-treated tendons compared to controls. Also, higher hydroxyproline content and improved collagen alignment along with lower inflammatory cell infiltration and decreased angiogenesis were observed in blastema-treated tendons. CONCLUSION: Increased levels of hydroxyproline and improved histopathological and biomechanical parameters in the treatment group suggest that blastema cells could be considered an adjunct to tendon repair in rabbits.

[Surgical management of high-grade ear malformations in childhood]. / Chirurgische Therapie komplexer Fehlbildungen des kindlichen Ohrs.

Malformations of the ear are the most common dysplasias in childhood. Ear malformations are classified into dysplasias of the auricle, of the ear canal, and of the middle and inner ear. The latter types are fortunately relatively rare. Most common is a low-grade dysplasia of the auricle (otapostasis, cup ear). Higher-grade dysplasia of the auricle (microtia II-III) is often associated with syndromes and/or malformations of the ear canal and the middle ear (e.g., congenital aural atresia with high-grade microtia and dysplasia of the middle ear). Functional aspects of hearing and acquisition of language as well as aesthetic aspects emphasize the importance of surgical therapy. Due to the importance of correctly scheduling surgical treatment in early childhood, this article gives an overview of the possibilities for aesthetic reconstruction of the auricle and the frequently associated functional rehabilitation of hearing.

Transposição de lóbulo de orelha: um retalho simples para reconstrução de defeito cirúrgico de espessura total do antítrago / Earlobe transposition: a simple flap in the reconstruction of fullthickness surgical defect of anti-tragus

O câncer de pele ocorre com frequência na região do pavilhão auricular. A conformação tridimensional e a disponibilidade limitada de pele redundante regional tornam a reconstrução desta área anatômica desafiadora. Relata-se a reconstrução de antítrago utilizando-se um retalho de transposição de lóbulo de orelha

Skin cancer frequently occurs on the pinna. The three-dimensional conformation and the limited availability of redundant regional skin make the reconstruction of this anatomical area challenging. We report the reconstruction of anti-tragus using an earlobe transposition flap

Umbilicated Hairy Auricular Mass Mimicking Accessory Tragus.

Trichofolliculoma (TF) is a follicular hamartoma in which hairs protruding out of single orifice. To the best of my knowledge, only two auricular TF has been reported in the English literature. Moreover, clinically TF have been described to mimic malignancy. I present a case of an adult female with mass at the intertragal notch of the left auricle for several years. The clinical diagnosis was thought to be epidermoid cyst, accessory tragus, and other benign skin adnexal tumor. To prevent recurrence, the wide local excision of the mass was performed. The final diagnosis of TF was made. No recurrence was noted during the follow-up of 1 year. It is important for otologists to be familiar with the clinical and pathologic characterization of TF, to make the correct diagnosis.