The Social Perception of Microtia and Auricular Reconstruction.

OBJECTIVES: To examine the social perception of microtia and quantify the effect of reconstruction on socially perceived attributes. METHODS: Parental consent was obtained for peri-reconstruction photographs in a patient with unilateral grade 3 microtia without an underlying craniofacial syndrome. With computer simulation, the normal, preoperative microtia, and postoperative reconstruction ear were isolated and blended into the oblique and lateral views of that volunteer's face to isolate ear morphology as a variable against a constant facial baseline. These photographs were embedded into Web-based surveys with visual analogue scales to capture social perception data and then were sourced to general population adults. RESULTS: Survey respondents totaled 631. On average, the face with the microtia ear was perceived to be less friendly (P = .015), less healthy (P = .022), and less successful (P = .005) than the same face with the "normal" ear. There were no statistically significant differences in socially perceived attributes between the face with the normal ear and the face with the reconstructed ear. CONCLUSION: This is the first study to examine the social perception consequences of microtia and microtia reconstruction in children. These findings may explain the significant psychosocial distress experienced by these patients by exploring the social perception of specific attributes perceived. Lastly, this study may better inform microtia patients and their physicians on the impact of auricular reconstruction on third party's perception of social attributes. LEVEL OF EVIDENCE: N/A Laryngoscope, 131:195-200, 2021.

An Account of the Inaugural Tessier Skull Exhibition at the University of Paris Descartes.

Paul Tessier is widely regarded as the father of modern craniofacial surgery. Upon his passing in 2008, his private collection of human skulls was purchased by the French Association of Facial Surgeons to ensure the collection would remain in France. The first public exhibition of the skulls was held in the medical museum of the University of Paris Descartes in April 2014. From this collection of skulls and the imagination of Tessier an entirely new specialty was created. Modern craniofacial surgery, now is an integral part of any pediatric plastic surgery department. Cranial and facial osteotomies have also become commonplace in both traumatic and aesthetic surgery. The goals for craniofacial deformity are now a return to completely normal appearance and function, as Tessier always believed they should be.

Reconstruction of Punitive Ear Amputations in Uganda: A Unique Surgical Burden of Disease.

Over the course of 12 months, a plastic surgical team from Paris, France, undertook 2 intensive ear reconstruction missions with plastic surgeons from the CoRSU Rehabilitation Hospital in Uganda. A cohort of over 30 adult women was assessed having been subjected to ear amputations by members of the Lords Resistance Army in Northern Uganda in the 1990s. The patients were identified, mobilized, and transferred to Kampala for surgery by a charitable arm of the Watoto Church, known as Living Hope. The surgical team performed 15 ear reconstruction cases during the first 1-week mission and 16 ear reconstruction cases during the second 1-week mission. All cases were reconstructed successfully using the 2-stage autologous auricular reconstruction method advocated by the senior author (FF). Local skin was used to cover the costal cartilage framework in the first stage without need for temporo-parietal fascial flaps. Technical challenges included the older age of patients and ossified costal cartilage, high prevalence of HIV positivity, bilateral amputation, and difficulty of surgical follow-up. The main modifications to standard practice were routine pre-op testing of the costal cartilage, pre-op viral load and CD4 count screening in HIV-positive patients, simultaneous bilateral first-stage ear reconstruction, prolonged hospital stay, and implementation of routine surgical counting procedures.

Classificação cirúrgica de Firmin para deformidades de orelha: análise crítica de série de casos operados no Brasil / Firmin’s surgical classification for ear deformities: critical analisys of a series operated in Brazil

A reconstrução para corrigir as deformidades auriculares, congênitas ou adquiridas, é uma cirurgia desafiadora devido à grande variabilidade clínica e dos tipos de tratamento. Firmin descreveu uma classificação cirúrgica com a finalidade de auxiliar o cirurgião plástico na realizaçãodo tratamento. Objetivo: Demonstrar que não existe uma regra única entre os tipos clínicos e os possíveis tipos de incisão na pele e apresentar a melhor maneira de utilizar a classificação cirúrgica de Firmin. Método: Foram avaliados 12 pacientes, todos portadores de deformidades congênitas ou adquiridas. Os pacientes foram classificados clínica e cirurgicamente pela autora sênior. Foram excluídos do estudo os pacientes submetidos à reconstrução de orelha sem a necessidadede cartilagem costal, utilizando cartilagem conchal da orelha contralateral. Todos os pacientes foram submetidos à reconstrução de orelha e acompanhados por um ano. Foi avaliado também o índice de complicações. Resultados: As classificações cirúrgicas de incisão na pele foram: 3 pacientes tipo II, 2 pacientes tipo IIIa e 4 pacientes tipo IIIb. Os tipos de maquete foram: 5 pacientes tipo I e 4 pacientes tipo III. Não houve mudanças das indicações cirúrgicas. O índice de complicações foi considerado baixo. Conclusão: A classificação cirúrgica de Firmin para reconstrução auricular demonstrou ser uma excelente ferramenta para direcionar o cirurgião plástico no planejamento terapêutico. O tipo de incisão, proposto por Firmin, a ser utilizado na correção cirúrgica tem relação com o tamanho e a localidade do remanescente auricular ou com sua ausência, e é independente da classificação clínica.

The reconstruction to correct microtias and acquired ear deformities is a defying surgery due to clinical variations and many forms of treatment. Rogers and Tanzer described the clinical classification that is the most utilized in the literature and Firmin described a surgical classification to assist the plastic surgeon in the treatment. Objective: Demonstrate that there is no strict indications between the clinical types and types of skin incision and to present the best way to use Firmin’s surgical classification. Methods: 12 patients with congenital (microtias) or acquired (burn sequela) ear deformities were evaluated. The patients were categorized clinically and surgically by the senior author. All patients under went reconstructive surgery and were followed up for one year. It was also evaluated the complication index. Results: The clinical classification was: 3 patients as small anomaly, 4 as lobular type, 3 as conchal type and 2 patients with total defect / burn sequel. The surgical classification of skin incision was: 3 patients as type II, 2 as type IIIa and 4 as type IIIb. For the framework was: 5 patients type I and 4 patients type III. The complication index was low. Conclusion: The Firmin’s surgical classification for ear reconstruction demonstrated to be an excellent tool to guide the plastic surgeon in the therapeutic treatment. The Firmin’s types of incision utilized in the corrective surgery have a relationship with the size and location of the auricular remanent and are independent of the clinical classification.

A novel algorithm for autologous ear reconstruction.

Sculpting a tridimensional autologous rib cartilage framework is essential to restore a natural ear shape and becomes routine with preoperative training, but management of the skin is the key to minimizing complications. Here the authors provide a classification scheme to manage auricular skin: Type 1 is a Z-plasty with transposition of the lobule; type 2 is a transfixion incision of the microtic ear; type 3 exposes the cartilage remnants through a cutaneous incision. They also explain how to choose between the three types, depending upon the auricular skin potential. With training and method, results in ear reconstruction using autologous rib cartilage are excellent and reproducible.

Use of the harmonic blade in face lifting: a report based on 420 operations.

BACKGROUND: An important concern for patients who undergo a face lift is the recovery time. Use of the Harmonic blade (Ethicon Endo-Surgery, Cincinnati, Ohio) for surgical dissection and hemostasis in face lift has improved recovery time and greatly reduced the risk of hematomas in the senior author's practice. METHODS: A retrospective study evaluated the complication rate using the Harmonic blade in face and neck lifting (n = 420) between 2001 and 2007. A prospective study was conducted on 100 cases (October of 2006 to May of 2008) to evaluate the mean operative time, drainage, and recovery time. Results at day 8 were evaluated using on a scale of 1 to 4 (1 = nil tracking to 4 = marked tracking). RESULTS: The complication rate in 420 cases was low and decreased with experience. Complications included hematoma (n = 5), temporary facial paresis (n = 4), submental lipolysis (n = 3), skin perforation (n = 1), minor skin burn (n = 1), skin necrosis (n = 0), and hair loss (n = 0). Mean operative time for face lift with a superficial musculoaponeurotic system procedure and anterior platysmaplasty was 180 minutes (range, 140 to 210 minutes). Drainage at day 1 was 20 cc (range, 0 to 30 cc). Average return to normal social life was by day 8 (range, 5 to 20 days). Results at day 8 were graded 1 for edema and ecchymosis. CONCLUSIONS: The beneficial effects of the Harmonic blade are obvious objectively and subjectively to both the surgeon and the patients. Understanding the key technical details involved with its use will improve the learning curve for the surgeon as this technology becomes an asset in face lifting.