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.

Lobe of sound: prosthetic rehabilitation of partial auriculectomy defect.

Loss of facial organs in an individual may be due to congenital anomalies or acquired causes. The missing parts of the face like ear, eyes and nose are considered as maxillofacial defects that can be rehabilitated by a prosthesis and/or cosmetic surgeries. This frontier of science has developed into a more reliable and predictable process due to the ever-increasing development of materials and equipments used in this procedure. The fabrication of an ear prosthesis is considered by many prosthetists to be one of the most difficult replacements in maxillofacial reconstruction. The severe undercuts and pronounced convolutions of the ear present a challenge in simulating a naturally proportioned prosthesis. Proper assessment of the disfigured facial organs and a feasible approach to rehabilitating them has for long been the target of clinical maxillofacial prosthodontics. This report describes a simple and engrossing technique to rehabilitate a patient with a partial auricular defect in the most aesthetic and economical manner using medical-grade room temperature vulcanising silicone.

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.

Unilateral Cauliflower Ear due to Leprosy or Trauma - A Diagnostic Challenge.

The terminology Cauliflower ear refers to the appearance of external ear, sequelae to underlying primary inflammation/infection. Trauma and secondary infection or perichondritis being the most common cause of cauliflower ear, this article describes a case of unilateral cauliflower ear due to multibacillary leprosy. This case shows the importance of skin smears and the histopathological identification and classification of leprosy patients with unusual lesions.

Diagnóstico por imagen: malformaciones congénitas y lesiones adquiridas del oído interno / Imaging diagnostics: congenital malformations and acquired lesions of the inner ear

Introducción: Las malformaciones congénitas y las lesiones adquiridas del oído interno se caracterizan por pequeños cambios estructurales de esta región. En las últimas décadas, las opciones terapéuticas han mejorado considerablemente, y paralelamente se ha producido un gran avance en los métodos diagnósticos, consiguiendo imágenes de alta resolución del laberinto. Actualmente se utiliza una tomografía computerizada multicorte de 64 detectores (Brilliance 64 Phillips, Eindhoven, the Netherlands), un espesor de adquisición de 0,66 y un intervalo de 0,33 mm, 120 KV y 300 mA. Las imágenes de resonancia magnética proceden de los equipos Signa HDxt 1.5 y 3.0 T (GE Healthcare, Waukesha, WI, USA). Se realiza una revisión de las características radiológicas de las lesiones que afectan al oído interno que son clasificadas según su origen en congénitas (malformaciones del laberinto y deficiencias de los nervios estatoacústicos) o adquiridas (otoespongiosis, laberintitis, hemorragia del oído interno, enfermedad de Menière, schwannoma intralaberíntico, tumor del saco endolinfático). Conclusiones: La resonancia magnética y la tomografía computerizada juegan un papel fundamental en el diagnóstico de pacientes con patología del oído interno. La técnica de elección debe ser escogida en función del escenario clínico. De forma genérica, para el estudio de patología traumática u otoespongiosis la tomografia es el método de elección. Ante sospecha de patología tumoral o inflamatoria la resonancia se muestra superior. Para el estudio de patología malformativa ambas técnicas son complementarias (AU)

Introduction: Congenital malformations and acquired lesions of the inner ear are characterised by small structural changes in this region. In recent decades, treatment options have improved considerably. At the same time, there has been a great advancement in diagnostic methods, obtaining high-resolution labyrinth images. Currently, we use a 64-multislice computed tomography scanner in spiral mode (Brilliance 64 Phillips, Eindhoven, the Netherlands), with an overlap of 0.66 mm and an interval of 0.33 mm, 120 KV and 300 mA. The magnetic resonance images were taken with Signa HDxt 1.5 and 3.0 T units (GE Healthcare, Waukesha, WI, USA). We reviewed the radiological features of the lesions affecting the inner ear. They are classified as congenital (labyrinth malformation and statoacoustic nerve deficiencies) or acquired (otospongiosis, labyrinthitis, Ménière's disease, inner ear haemorrhage, intralabyrinthine schwannoma and endolymphatic sac tumour). Conclusion: Magnetic resonance imaging and computed tomography play an essential role in diagnosing patients with inner ear pathology. The technique selected should be chosen depending on the clinical setting. In a generic way, tomography is the method of choice for the study of traumatic pathology or otospongiosis. When tumour or inflammatory pathology is suspected, magnetic resonance is superior. In cases of congenital malformation, both techniques are complementary (AU)

Long-term in vivo electromechanical reshaping for auricular reconstruction in the New Zealand white rabbit model.

OBJECTIVES/HYPOTHESIS: To demonstrate the dosimetry effect of electromechanical reshaping (EMR) on cartilage shape change, structural integrity, cellular viability, and remodeling of grafts in an in vivo long-term animal model. STUDY DESIGN: Animal study. METHODS: A subperichondrial cartilaginous defect was created within the base of the pinna of 31 New Zealand white rabbits. Autologous costal cartilage grafts were electromechanically reshaped to resemble the rabbit auricular base framework and mechanically secured into the pinna base defect. Forty-nine costal cartilage specimens (four control and 45 experimental) successfully underwent EMR using a paired set of voltage-time combinations and survived for 6 or 12 weeks. Shape change was measured, and specimens were analyzed using digital imaging, tissue histology, and confocal microscopy with LIVE-DEAD viability assays. RESULTS: Shape change was proportional to charge transfer in all experimental specimens (P < .01) and increased with voltage. All experimental specimens contoured to the auricular base. Focal cartilage degeneration and fibrosis was observed where needle electrodes were inserted, ranging from 2.2 to 3.9 mm. The response to injury increased with increasing charge transfer and survival duration. CONCLUSIONS: EMR results in appropriate shape change in cartilage grafts with chondrocyte injury highly localized. These studies suggest that elements of auricular reconstruction may be feasible using EMR. Extended survival periods and further optimization of voltage-time pairs are necessary to evaluate the long-term effects and shape-change potential of EMR. LEVELS OF EVIDENCE: NA.

Clinical results and health-related quality of life in otoplasty patients using cartilage resection and suturing methods.

In this study, we evaluated clinical results and health-related quality of life in our otoplasty patients in whom we used cartilage resection method (CRM) and suturing method (SM). A total of 132 ears of 77 patients (36 males, 41 females; mean age 14.6 ± 6.4) between January 2006 and February 2013 were included in this study. Patients were divided into two groups according to the type of surgery performed: Group 1 was the cartilage resection group (CRG) and Group 2 was the suturing group (SG). CRM was performed on 64 ears of 37 patients (unilateral in 10 cases and bilateral in 27 cases), and SM was performed on 68 ears of 40 patients (unilateral in 12 cases and bilateral in 28 cases). The parameters of the groups, including operation time, measurements of the auriculocephalic distances, complication rates, postoperative satisfaction rates, and health-related quality of life were compared. Mean operation time was 53.7 ± 7.8 min in the CRG and 44.9 ± 4.2 min in the SG (P ≤ 0.05). Mean postoperative auriculocephalic measurements were similar in both groups. The complications were more frequent in the CRG (10/37 patients, 27.02 %) than in the SG (3/40 patients, 7.54 %) with statistically significant difference (P < 0.05). Three months after the surgery, visual analog scale increased from 25 (preoperatively) to 70 in the CRG and from 30 to 90 in the SG, with a statistically significant difference (P < 0.05). Patients' health-related quality of life showed a statistically significant increase after the operation in both groups (P < 0.05). CRM and SM are effective treatment methods with high success rates for patients with prominent ears. In the selected cases, SM seems to represent a better option for otoplasty than CRM because clinical results, cosmetic outcomes, patient satisfaction, and health-related quality of life scores were better than CRM.

Tympanic membrane retraction pocket staging: is it worthwhile?

Our objectives were to review all reported staging systems of tympanic membrane (TM) retraction pockets (RP) and to report their reliability and utility to our daily clinical practice in terms of follow-up and decision making in the management of RP. We aim to propose a new management algorithm of TMRPs. We conducted a thorough research on Ovid Medline, Pubmed and Cochrane databases for English and French languages studies published between 1963 and 2012 on the retraction pocket. Studies were excluded if it were a short comments, photo clinical cases, experimental studies or round table articles. Cholesteatoma was not included in keywords, since it is considered as an advanced pathological entity with different staging and management approaches. We included 60 of 756 articles that met our inclusion criteria. Sadé and Berco proposed the first staging system of RP in 1976, while the last one was described by Borgstein et al. in 2007. From 1976 to 2007, 12 different staging systems have been described for tympanic membrane retractions. There are three broad categories of TMRPs: localized retractions of the pars tensa, generalized retractions of the pars tensa (atelectasis) and retraction of the pars flaccida. Most of the described staging systems are useful for following up the evolution of retractions over time. However, no consensus was found concerning the decision making in its management. In conclusion, proper management of TMRPs requires a reproducible, easily applicable staging system with low inter- and intra-observer variability. We propose a management algorithm that considers the functional handicap of the patient rather than the topographic description of the TM.

Cauliflower ear dissection.

Cauliflower ear (CE) is caused by repeated direct trauma to the external ear. Surgical correction of an established CE is one of the most challenging problems in ear reconstruction. However, no reports have clarified the dissection of an established CE in detail. In this report, the dissection of a CE is described based on macroscopic, microscopic and imaging features.

[Physical diagnosis: diagonal earlobe crease and atheromatous coronary].

Physical diagnosis is considered to be a cornerstone in clinical medicine. Examination of the ears is frequently forgotten although, in many clinical situations, it may help: in gout (tophi), lupus, congenital anomalies, trauma and in local malignancies. We may add another physical-acquired sign: the Frank's sign in which a diagonal notch in the ear lobe is found in patients with coronary heart disease.

Opções cirúrgicas nas malformações artério-venosas (MAV) de orelha com comprometimento cartilaginoso: relato de casos

Objetivo: As manifestações artério-venosas (MAV) são anomalias congênitas resultantes do desenvolvimento anômalo dos vasos sanguíneos. Estas podem ser de alto ou baixo fluxo, dependendo do vaso nutridor de lesão. Ao considerar MAVs de orelha, no entanto, algumas características particulares estimulam abordagem cirúrgica. Durante a fase de crescimento, obstrução do meato acústico externo, sangramentos, ulceração ou dor podem coexistir com deformidades anatômica e transtornos psicológicos. Após a fase de crescimento pode haver estabilização, e as deformidades anatômicas cartilaginosas podem ocorrer em decorrência de deficiência de desenvolvimento por alteração na vascularização do local, por efeito de massa tumoral com compressão direta na cartilagem provocando desde deformidades leves até erosões e destruição do arcabouço cartilaginoso. Serão relatados quatro casos de MAV de orelha e suas diferentes opções terapêuticas. Relato de casos: Caso 1 - OBS, 33 anos, sexo masculino, MAV extensa de orelha com episódios freqüentes de ulceração e sangramentos, tendo sido submetido a dois procedimentos de escleroterapia sem sucesso. Submetido a embolização local no dia anterior à cirurgia, com opção cirúrgica de exérese de toda MAV com preservação cutânea da parte posterior à orelha e lóbulo e todo arcabouço cartilaginoso. Para reconstrução foi feito um retalho em "cambalhota" da fáscia temporal para propiciar leito viável para então proceder à enxertia cutânea com pele parcial de face anterior de coxa. Caso 2 - CA, 22 anos, sexo masculino, MAV de orelha com comprometimento parcial de orelha com destruição de cartilagem. Procedimento cirúrgico realizado incluiu ressecção parcial e reconstrução com Medpor. Caso 3 - JV, 8 anos, sexo masculino, MAV de pólo superior de orelha. Procedimento cirúrgico realizado incluiu ressecção local com fechamento local primário com princípio cirúrgico em "estrela"...

[Diagonal earlobe crease, a sign of coronary artery disease]. / Surco diagonal en el lóbulo de la oreja, signo de enfermedad arterial coronaria?

The diagonal earlobe crease is a sign theorically related to coronary artery disease. The purpose of this study was to prove the usefulness of this sign. A total of 104 patients were examined (ages 30 to 80) grouped by age and sex. Forty nine of them were diagnosed of having coronary artery disease by coronary angiography (a 70% obstruction of one of the major arteries), and/or myocardial perfusion imaging with Thallium 201 (fixed defects). The control group included 55 patients (asymptomatic with normal electrocardiogram). Data here obtained included sensitivity (61.2%), specificity (78 2%), positive predictive value (71.4%) and negative predictive value (69.3%). We found a significant relation between the presence of the diagonal earlobe crease and coronary artery disease. We consider it a sign that could prove useful in clinical practice, mainly among patients aged between 30 and 60.

Surco diagonal en el lóbulo de la oreja: ¿signo de enfermedad arterial coronaria? / Diagonal earlobe crease, a sign of coronary artery disease?

El surco diagonal es un signo encontrado en el lóbulo de la oreja, que estaría relacionado con la enfermedad arterial coronaria. Nuestro objetivo fue estudiar la utilidad del signo. Se examinaron 104 pacientes (entre 30 y 80 años) clasificados por sexo y edad. Cuarenta y nueve tenían enfermedad arterial coronaria diagnosticada por coronariografía (obstrucción > del 70% en una de las grandes arterias) y/o gamagrafía de perfusión miocárdica con Talio 201 (defecto fijo). El grupo control estuvo compuesto por 55 pacientes (asintomáticos, con electrocardiograma normal). Los datos obtenidos fueron sensibilidad (61.2%), especificidad (78.2%), valor predictivo positivo de (71.4%) y valor predictivo negativo (69.3%.). Observamos una relación significativa entre la presencia de surco diagonal y enfermedad arterial coronaria. Consideramos que este signo podría resultar de utilidad en la práctica clínica, fundamentalmente para los pacientes entre 30 y 60 años.

The diagonal earlobe crease is a sign theorically related to coronary artery disease. The purpose of this study was to prove the usefulness of this sign. A total of 104 patients were examined (ages 30 to 80) grouped by age and sex. Forty nine of them were diagnosed of having coronary artery disease by coronary angiography (a 70% obstruction of one of the major arteries), and/or myocardial perfusion imaging with Thallium 201 (fixed defects). The control group included 55 patients (asymptomatic with normal electrocardiogram). Data here obtained included sensitivity (61.2%), specificity (78.2%), positive predictive value (71.4%) and negative predictive value (69.3%). We found a significant relation between the presence of the diagonal earlobe crease and coronary artery disease. We consider it a sign that could prove useful in clinical practice, mainly among patients aged between 30 and 60.

Surco diagonal en el lóbulo de la oreja: ¿signo de enfermedad arterial coronaria? / Diagonal earlobe crease, a sign of coronary artery disease?

El surco diagonal es un signo encontrado en el lóbulo de la oreja, que estaría relacionado con la enfermedad arterial coronaria. Nuestro objetivo fue estudiar la utilidad del signo. Se examinaron 104 pacientes (entre 30 y 80 años) clasificados por sexo y edad. Cuarenta y nueve tenían enfermedad arterial coronaria diagnosticada por coronariografía (obstrucción > del 70% en una de las grandes arterias) y/o gamagrafía de perfusión miocárdica con Talio 201 (defecto fijo). El grupo control estuvo compuesto por 55 pacientes (asintomáticos, con electrocardiograma normal). Los datos obtenidos fueron sensibilidad (61.2%), especificidad (78.2%), valor predictivo positivo de (71.4%) y valor predictivo negativo (69.3%.). Observamos una relación significativa entre la presencia de surco diagonal y enfermedad arterial coronaria. Consideramos que este signo podría resultar de utilidad en la práctica clínica, fundamentalmente para los pacientes entre 30 y 60 años.(AU)

The diagonal earlobe crease is a sign theorically related to coronary artery disease. The purpose of this study was to prove the usefulness of this sign. A total of 104 patients were examined (ages 30 to 80) grouped by age and sex. Forty nine of them were diagnosed of having coronary artery disease by coronary angiography (a 70% obstruction of one of the major arteries), and/or myocardial perfusion imaging with Thallium 201 (fixed defects). The control group included 55 patients (asymptomatic with normal electrocardiogram). Data here obtained included sensitivity (61.2%), specificity (78.2%), positive predictive value (71.4%) and negative predictive value (69.3%). We found a significant relation between the presence of the diagonal earlobe crease and coronary artery disease. We consider it a sign that could prove useful in clinical practice, mainly among patients aged between 30 and 60.(AU)