Earfold™: A combined approach with conchal bowl reduction.

BACKGROUND: Prominent ear deformity is common amongst the human population and is partly due to underdevelopment of the antihelical fold, a prominent conchal bowl, or both. Recently, the senior author described a minimally invasive technique for changing the shape of the antihelical fold using the Earfold™ implant (Allergan plc, Dublin, Ireland). However, there is still a paucity of data regarding outcomes from combing this approach with surgical techniques to correct conchal bowl hypertrophy. OBJECTIVES AND METHODS: Questionnaire-based study evaluating outcomes in consecutive patients undergoing treatment with Earfold™ and conchal bowl reduction. Patient reported outcome measures were assessed with a validated questionnaire. Data on complications were obtained from the patient's case notes and free-text sections of the questionnaire. RESULTS: Completed questionnaires were received from 8 patients out of a total of 18 who underwent the combination treatment (44% response rate). Statistically significant differences were noted in nearly all questions (18/19) relating to changes in ear appearance as a result of the surgery, with all patients being satisfied following the combined procedure. Improvements in subjective outcomes were compared to previous studies evaluating treatment with Earfold™. CONCLUSIONS: The Earfold™ implant can be combined safely with other otoplasty techniques to achieve a good outcome in a carefully selected patient population.

Burned Ear Reconstruction Using a Superficial Temporal Fascia Flap.

OBJECTIVES: Ear deformity caused by burns is one of the most difficult types of deformity to treat with plastic surgery, and the reconstruction of burned ears undoubtedly remains a substantial challenge. This study aims to report the therapeutic regime of using a superficial temporal fascial flap to cover the framework in burned ear reconstruction. METHODS: Autologous costal cartilage was used to form the ear framework in all of the reconstruction cases. A superficial temporal fascial flap was used as soft tissue to cover the ear scaffold. RESULTS: Five patients with 6 ears were included in our study. The external ear healed well and the location, size, and shape of both ears were generally symmetrical. No complication was observed in any of the patients. CONCLUSIONS: The superficial temporal fascial flap is a good choice for covering the autogenous cartilage framework when treating ear deformities after burns.

Criptotia em paciente ocidental adulto: relato de caso / Cryptotia in a Western adult patient: a case report

Criptotia é uma deformidade auricular congênita comum em orientais e rara em ocidentais, sendo a grande maioria dos estudos de técnicas cirúrgicas orientais e aplicados em crianças. Nesta patologia, a cartilagem do polo superior da orelha encontra-se alojada embaixo da pele na região temporal, o que impossibilita o uso de óculos, devido à falta de apoio e torna o polo superior sem definição estética. O presente estudo tem por objetivo relatar o caso de um paciente adulto com criptotia, submetido ao tratamento cirúrgico com retalho de pedículo subcutâneo mastóideo, revisando as principais técnicas descritas para o tratamento deste acometimento. O retalho de pedículo subcutâneo descrito por Yoshimura, mostrou-se adequado para a correção da criptotia em paciente ocidental e adulto.

Cryptotia is a congenital ear deformity common in Easterners and rare in Westerners, with most studies addressing Eastern surgical techniques applied to children. In this pathology, the cartilage of the upper pole of the ear is lodged subcutaneously in the temporal region, which prevents individuals from using glasses due to lack of support and prevents esthetic definition of the upper pole. The present study aimed to report the case of an adult patient with cryptotia undergoing surgical treatment using a mastoid subcutaneous pedicle flap and review the main techniques described for the treatment of this involvement. The subcutaneous pedicle flap described by Yoshimura proved to be adequate for correcting cryptotia in a Western adult patient.

Retalho retroauricular ilhado para reconstrução parcial de orelha: relato de casos / Retroauricular island flap for partial ear reconstruction: case reports

Defeitos parciais de orelha podem ser tratados de diversas formas, dentre elas o fechamento primário, cicatrização por segunda intenção ou retalhos. Diversas opções técnicas foram descritas para a sua reconstrução de modo a manter o contorno natural da orelha, sem sacrificar tecido sadio ou alterar sua estética e função. Apresentamos neste artigo dois casos atendidos no Instituto do Câncer do Hospital de Base de São José do Rio Preto de reconstrução de defeitos condrocutâneos de orelha após ressecção de carcinoma basocelular em região central da orelha, com a confecção de retalho retroauricular ilhado transposto através de uma janela cartilaginosa e com o pedículo desepidermizado. Área doadora com fechamento primário. Tal procedimento constitui técnica segura, pois a região retroauricular é ricamente vascularizada, é de fácil execução, em único estágio e com resultado estético e funcional satisfatório.

Partial ear defects can be treated in several ways, including primary closure, healing by secondary intention, or flaps. Several surgical options have been described for reconstruction in order to maintain the natural contour of the ear, without sacrificing healthy tissues or changing the aesthetics and function. In this article, we present two cases of reconstruction of chondrocutaneous defects of the ear after resection of basal cell carcinoma in the central region of the ear, with the production of a retroauricular island flap transposed through a cartilaginous window with the de-epidermized pedicle. The donor area healed following a primary closure. This procedure can be performed in a single stage, yields satisfactory aesthetic and functional results, and is safe because the retroauricular region is richly vascularized.

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.

Otoplastia Combinada / Combined Otoplasty

Introdução: Orelha em abano é a deformidade congênita mais comum de cabeça e pescoço, cuja transmissão se dá por herança autossômica dominante, sem predileção por gênero. A orelha proeminente ou "em abano" ocorre quando há um excesso ou hipertrofia da concha auricular, apagamento da antélice, um ângulo escafoconchal maior que 90º ou uma combinação destes, ocorrendo uni ou bilateralmente. O objetivo é apresentar uma abordagem conservadora para correção de orelha em abano, com a associação de técnicas. Métodos: Foi utilizada uma variação cirúrgica para realização de otoplastia com o auxílio de uma abordagem anterior para ressecção da concha auricular associada ao enfraquecimento da antélice com incisões parciais na cartilagem também por via anterior e a realização de pontos de Mustardé por via posterior para melhor definição da antélice, sem a fixação da concha à mastoide. Foram operados 200 pacientes com idade média de 17 anos, entre janeiro de 1987 e janeiro de 2015, sendo 60% do gênero feminino. Resultados: Dos 200 pacientes, apenas 24 necessitaram revisões cirúrgicas discretas. Conclusão: O procedimento cirúrgico é simples, facilmente reprodutível, proporcionando bons resultados, com alto grau de satisfação e baixo índice de complicações/morbidade.

Introduction: Protruding ear is the most common congenital deformity of the head and neck, with an autosomal dominant inheritance and no predilection for sex. Protruding ear or prominent ear occurs when there is concha excess or hypertrophy, erasure of the antihelix, a scapho-conchal angle greater than 90°, or a combination of these factors, occurring unior bilaterally. The objective is to present a conservative approach to correct protruding ear, with a combination of techniques. Methods: The otoplasty surgical technique involved an anterior approach for resection of the auricular concha, which was associated with weakening of the antihelix, and partial incisions of the cartilage were performed through anterior access and of Mustardé sutures, through posterior access for better definition of the antihelix without fixation of the concha to the mastoid. Two hundred patients with a mean age of 17 years underwent operations between January 1987 and January 2015, 60% of whom were female. Results: Of the 200 patients, only 24 patients needed discrete surgical revisions. Conclusion: The surgical procedure is simple, easily reproducible, provides good results, and is associated with a high degree of satisfaction and a low rate of complications/morbidities.

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.

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.

Surgical correction of cryptotia combined with an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap.

BACKGROUND: Cryptotia is a common congenital ear deformity in Asian populations. In cryptotia, a portion of the upper ear is hidden and fixed in a pocket of the skin of the mastoid. Here we describe our method for cryptotia correction by using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap. PATIENTS AND METHODS: We developed a new method for correcting cryptotia by using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap. Following ear release, the full-thickness skin rotation flap is rotated into the defect, and the donor site is covered with an ultra-delicate split-thickness skin graft raised in continuity with the flap. RESULTS: All patients exhibited satisfactory release of cryptotia. No cases involved partial or total flap necrosis, and post-operative outcomes using this new technique for cryptotia correction have been more than satisfactory. CONCLUSIONS: Our method of using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap to correct cryptotia is simple and reliable.

Repair of Auricular Defects.

Repairing defects of the auricle requires an appreciation of the underlying 3-dimensional framework, the flexible properties of the cartilages, and the healing contractile tendencies of the surrounding soft tissue. In the analysis of auricular defects and planning of their reconstruction, it is helpful to divide the auricle into subunits for which different techniques may offer better functional and aesthetic outcomes. This article reviews many of the reconstructive options for defects of the various auricular subunits.

[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%.

Bone Anchored Hearing Aid (BAHA) in children: Experience of a tertiary referral centre in Portugal / Prótesis auditivas osteointegradas en niños: experiencia de un centro terciario de referencia en Portugal

Objectives: The aim of this study is to describe the experience of a tertiary referral centre in Portugal, of the placement of BAHA in children. Methods: The authors performed a retrospective analysis of all children for whom hearing rehabilitation with BAHA was indicated at a central hospital, between January 2003 and December 2014. Results: 53 children were included. The most common indications for placement of BAHA were external and middle ear malformations (n=34, 64%) and chronic otitis media with difficult to control otorrhea (n=9, 17%). The average age for BAHA placement was 10.66±3.44 years. The average audiometric gain was 31.5±7.20dB compared to baseline values, with average hearing threshold with BAHA of 19.6±5.79dB. The most frequent postoperative complications were related to the skin (n=15, 28%). There were no major complications. Conclusions: This study concludes that BAHA is an effective and safe method of hearing rehabilitation in children (AU)

Objetivos: El objetivo de este estudio es describir la experiencia de un centro terciario de referencia en Portugal, en la colocación de prótesis auditivas osteointegradas (BAHA) en los niños. Métodos: Los autores realizaron un análisis retrospectivo de todos los niños con indicación para rehabilitación auditiva con BAHA en un hospital central, entre enero de 2003 y diciembre de 2014. Resultados: Se incluyeron 53 niños. Las indicaciones más frecuentes para la colocación de BAHA fueron las malformaciones del oído externo y medio (n=34; 64%) y la otitis media crónica con otorrea de difícil control (n=9; 17%). La edad media de la colocación de BAHA fue de 10,66±3,44 años. La ganancia de audiometría promedio fue de 31,5±7,20dB en comparación con los valores basales, con un umbral medio de audición con BAHA de 19,6±5,79dB. Como complicaciones postoperatorias, las más frecuentes se relacionaron con la piel (n=15; 28%). No hubo complicaciones mayores. Conclusiones: En este estudio se concluye que la BAHA es un método eficaz y seguro de rehabilitación auditiva en niños (AU)

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.

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.

[Application of multislice computed tomography volume rendering and 3D printing technique of costal cartilage for auricular reconstruction].

Objective: To investigate the value of Multislice computed tomography volume rendering(VR) technique and 3D printing technique in auricular reconstruction. Methods: Six patients were enrolled for auricular reconstruction with costal cartilage,including 5 congenital microtia patients and 1 traumatic auricular defect patient. We harvest the three-dimensional reconstructive data of the contralateral sixth, seventh, eighth and ninth costal cartilage with VR technique.Three-dimensional solid models were 3D printed with nylon material according to the data exported in STL format.Preoperativesimulation was performed on the models, accordingly, we determined the strategies of costal cartilage harvest and framework fabrication, and operations were performed based on the pre-designed plan. Results: In all 6 patients, the actual costal cartilage harvest and framework fabrication process was consistent with the preoperative design and simulation results, and more scientific than before.The shapes of reconstructed ears were vivid and natural. No complications such as infection,absorption,distortion and chest deformity happened. Conclusions: Through costal cartilage VR and 3D printing technique, we could make more reasonable preoperative design and simulation. The results can be improved with reduced injury, while avoiding the risks of thoracic deformity.

Tratamento de deformidade auricular / Treatment of Auricular Deformity

Neste artigo, apresentamos um caso de uma deformidade auricular de difícil correção cirúrgica, envolvendo unidade escafo-helicoidal associada com a orelha proeminente em uma paciente de 25 anos de idade. Esta é uma malformação congênita incomum da orelha, o que resulta em uma borda helicoidal achatada, não curvilínea e dobrada sobre a escafa, comprometendo a aparência helicoidal. Foi proposto um tratamento cirúrgico com abordagem posterior e enxerto de cartilagem conchal à restauração do contorno borda helicoidal em um procedimento único. Esta nova abordagem proporciona um resultado agradável para o ouvido, principalmente por restaurar uma nova unidade escafo-helicoidal sem cicatriz na superfície orelha anterior e tratamento da orelha proeminente.

In this paper, we present a case of auricular deformity whose surgical correction is difficult, involving scapha-helical unit associated with prominent ear in a 25-year-old female patient. This is an uncommon congenital malformation of the ear, resulting in a flattened, straightened and folded helical rim over the scapha, compromising the helical appearance. The proposed surgical treatment involved posterior approach and conchal cartilage graft to the restoration of the helical rim contour in a single procedure. This new approach provides a fine result to the ear, particularly because it restores the scapha-helical unit with no scar on the surface of the anterior ear and also effectively treats the prominent ear.