Analysis of the effect and influencing factors of EarWell auricle orthosis in the treatment of congenital auricle deformity in children.

OBJECTIVE: To observe the efficacy of EarWell ear orthosis in treating children with different types of ear deformities. METHODS: We selected 80 children aged <6 weeks with ear deformities (110 ears: 15, 30, 21, 25, and 19 ears with prominent ear, lop ear, cup ear, cryptotia, and helical rim deformity, respectively). Differences in effectiveness rate, treatment time, and incidence of complications among children with different types of auricular deformities were compared. Recurrence rates at 1 and 3 months after the treatment were compared. RESULTS: The overall success rate was 92.73 %, and the treatment effectiveness rate did not differ significantly among the children with different types of auricular malformations (P > 0.05). The correction time of the helical rim deformity was the shortest, and the correction times of the prominent and cup ears were significantly longer than those of the other groups (P < 0.05). The incidence of complications associated with helical rim deformity and lop ear was lower, and the incidence of prominent and cup ear complications was significantly higher than that in the other groups (P < 0.05). The recurrence rate in children with prominent and cup ears was higher at 1 and 3 months after correction, and children with a lop ear and cryptotia showed no recurrence at 1 and 3 months after treatment, which correlated with the correction time, incidence of complications, and recurrence rate (P < 0.05) CONCLUSION: The EarWell auricle orthosis is an effective treatment in children with auricular morphological malformations. Correction time, complication rate, and recurrence rate were related to the malformation type.

[Analysis of risk factors for congenital auriclar deformity and its different types].

Objective:To Explore the clinical characteristics,risk factors,and differences in risk factors for different types of congenital auricular deformities,in order to provide theoretical basis for precise prevention and control of congenital auriclar deformity. Methods:Full-term newborns born in the Second Affiliated Hospital of Zhengzhou University from May 2022 to January 2023 were screened for auricle malformation, general information and data were collected,,and high-risk factors were investigated withself-made questionnaire.Using a case-control study method,newborns with auriclar deformities were selected as the case group and those without auriclar deformities during the same period were selected as the control group.A case-control study was conducted to analyze the incidence rate,high-risk factors,and differences in high-risk factors for different types of auricle deformities. Results:A total of 1 758 newborns （3 516 ears） were included in this study,including 562 newborns（927 ears） with auriclar deformities,the incidence of congenital malformations of the auricle is 26.37%.Among them,289 ears （8.22%） were helical rim deformity,244 ears （6.94%） were lidding/lop ear,166 ears （4.72%） were mixed deformities,131 ears （3.73%） were prominent/cup ear,79 ears （2.25%） were Stahl's ears,16 ears （0.46%） were abnormal conchal crus,and 2 ears （0.06%） were cryptotia.Maternal history of infection in early pregnancy（OR=1.513，95%CI 1.119-2.045）,previous miscarriage history（OR=1.300，95%CI 1.049-1.613）,and abnormal pregnancy（OR=1.278，95%CI 1.032-1.582） are risk factors for congenital auricular malformations.There was no statistically significant difference in the history of infection（χ²=1.877，P=0.391）,previous miscarriage（χ²=4.706，P=0.095）,and abnormal pregnancy（χ²=5.026，P=0.081） among mothers with helical rim deformity,lidding/lop ear,and mixed deformities. Conclusion:The incidence rate of congenital auricle deformity is high, with common malformations such as helical rim deformity, lidding/lop ear,and mixed deformities. Congenital auricular deformity is caused by various factors, the same risk factor has roughly the same impact on different types of morphological abnormalities.

Innovated surgery incision for patients of congenital malformation of the middle and outer ear with infection (CMMOEI).

BACKGROUND: It is the challenging clinical issue of combining debridement of infected lesions and retaining the blood skin flap for auricle reconstruction in patients of Congenital Malformation of the Middle and Outer Ear with Infection (CMMOEI). AIMS/OBJECTIVES: To innovate and introduce an surgery incision to solve the challenging clinical issue of a combined debridement of infection yet retaining a well vascularized skin flap for auricle reconstruction in patients with CMMOEI. MATERIAL AND METHODS: A combined innovated incision of ear sulcus and prefabricated earlobe was used for 23 cases (23 ears) with CMMOEI, The success in the management of the encountered infections, and the short and moderate-term outcome of the innovated incision to preserve a well-vascularized skin flap for subsequent auricle reconstruction were reviewed. The 23 cases include 10 males and 13 females, aged 4-14 years (mean 8.4 years), 7 left ears and 16 right ears. 14 ears stenosis and 9 ears atresia of the outer ear canals. RESULTS: In all 23 cases, the infections were successfully cleared without recurrence or complication with 2-year follow-up. The local skin flap and its blood supply were well preserved for subsequent auricle reconstruction. CONCLUSIONS AND SIGNIFICANCE: The new incision can facilitate clearance of infection in CMOMEI patients, and preserve the retroauricular tissues for subsequent harvesting of a well-vascularized skin flap for subsequent auricle reconstruction.

[Clinical application of retrosigmoid approach for BONEBRIDGE implantation after auricle reconstruction using expanded postauricular flap].

Objective: To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap. Methods: A retrospective analysis was conducted on 43 congenital aural atresia cases (43 ears) who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital. 30 males and 13 females were included in this work. The implantation age was 9-36 years old (median age=10 y/o). All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method, with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method. BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages. The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation. Routine follow-up was conducted to observe the hearing results and complications. SPSS 14.0 software was applied for data statistical analysis. Results: All 43 patients healed well and had no surgical complications when discharge. The average bone conduction hearing threshold after surgery was (8.2±6.6) dBHL, and there was no statistically significant difference compared to the preoperative [(8.1±5.7) dBHL] (P=0.95). After surgery, the threshold of hearing assistance with power on was significantly lower than that without hearing assistance [(32.8±4.6) dBHL vs (60.5±5.5) dBHL], and the difference was statistically significant (P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased to 72%, 84%, and 98% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words, and short sentences in noise environment was significantly increased by 70%, 80%, and 92% respectively (P<0.001). After a follow-up of 4 to 47 months (median=24 months), the hearing results were stable and the aesthetic outcomes were satisfying. One patient had delayed hematoma around coil of the implant. After aspiration and compressed dressing for one week, hematoma was not recurrent. Conclusion: For patients after auricle reconstruction using expanded postauricular flap, the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation, as well as aesthetic appearance.

Management of helical adhesion malformation.

Congenital auricular anomalies are common, however very few articles in the English literature address helical adhesion malformation, whereby the helix is adhered to the scapha. We describe a surgical approach to correct helical adhesion malformation which, unlike previously described methods, is simpler and results in an inconspicuous scar on the back of the ear. We illustrate our technique with an 11-year-old girl with bilateral helical adhesion malformations. Satisfactory ear shape was achieved bilaterally without complication. Meticulous dissection over the helix and exposure beyond the adhesion is of paramount importance in successfully correcting this malformation. Through a posterior auricular incision, this wide exposure and visualisation of the helix can be attained, with the added benefit of a scar hidden on the back of the ear.

Utilization of intense pulsed light for hair removal in pediatric auricular reconstruction using tissue expander: A retrospective cohort study.

This study aimed to investigate the safety and efficacy of depilation with intense pulsed light (IPL) in congenital microtia patients during their reconstruction treatment. The hairy skin was treated with the M22TM system (Lumenis, German) using a filter of 695 to 1200 mm. A contact prob with a window of 15 cm × 35 mm or 8 cm × 15 mm was used at a radiant setting of 14 to 15 J/cm2 in the non-expander group and 13 to 14 J/cm2 in the expander group, both in a single pulse mode. The efficiency index of hair removal was classified based on the percentage of hair density reduction as excellent (>75%), good (50-75%), fair (25-50%), poor (<25%). The depilation effect was compared between the 2 groups, and any adverse effects were evaluated. A total of 159 patients were included, with 93 patients in the expander group and 66 in the non-expander group. The reduction of the hair density in the expander group after 3 treatments was higher than that in the non-expander group [82.98 (73.47-89.09)% vs 77.84 (71.50-85.34)%; P < .05, Wilcoxon rank-sum test], as well as the efficiency [excellent cases 68 (73.12%) vs 37 (56.06%); P < .05, Chi-square test]. Four cases of folliculitis, 3 cases of blisters, and no instance of expander exposure and cartilage absorption were observed in this study. Hair removal with IPL is a safe and effective photo-epilation method during all stages of ear reconstruction using tissue expander. Depilation in the skin expansion period resulted in better outcomes after 3 treatments, although after 5 treatments no difference between the 2 groups was observed.

Update on congenital ear molding.

PURPOSE OF REVIEW: Congenital ear deformities are characterized by distorted, but still present, landmarks of the auricle. Interventions include early treatment with ear molding or delayed surgical treatment. The purpose of this review is to provide an update on the latest information related to ear molding for congenital ear deformities. RECENT FINDINGS: Various ear molding techniques date back to the 1980s, but with the availability of commercially available molding systems, interest and use has blossomed in recent years. As more longitudinal research results are obtained, ear molding has been proven to be a highly effective treatment, although the best technique and length of treatment remains unclear. SUMMARY: While it is clear that earlier intervention is ideal, due to lack of public awareness, patients often present later, and it remains controversial what age to offer ear molding interventions to and still expect success. Ear molding interventions are becoming increasingly covered by insurance due to evidence of preventing long-term psychological morbidities and the need for future surgical interventions.

Vertical mattress suture applied as "tension band fixation" for the antihelix creation and prominent ear treatment: 104 case reports.

BACKGROUND: Prominent ears were the most common auricular deformity. Different surgical techniques, such as cartilage-cutting techniques and suturing techniques, are available for treatment. The horizontal mattress suture technique, represented by the Mustard technique, is widely accepted, while the vertical mattress suture technique is rarely discussed in otoplasty. METHOD: A total of 104 cases of prominent ear deformities were treated from January 2017 to December 2020. Several hypothetical "tension bands" perpendicular to the natural curvature of the antihelix were introduced for the surgical design and determination of the position of the antihelix fixation, and vertical mattress sutures were placed accordingly for the auricular cartilage fixation. RESULT: Follow-up ranged from 3 months to 2 years. No complications, such as hematoma, infection, or poor wound healing, were observed. Three patients had recurrence within two months post operation, and one complained about the overfolded antihelix. Three cases had suture exposure, but the shape of the auricle was not affected after suture removal. The surgical result was evaluated according to the overall shape of the auricle, including the shape of the antihelix, the improvement of the prominent, the surgical marks, and the bilateral symmetry. A total of 98 patients (94.23%) rated the results as "very satisfactory" or "satisfactory". CONCLUSION: The vertical mattress suture applied as "tension band fixation" could provide stable cartilage fixation with the natural appearance of the antihelix formation. In addition, the technique could fit a wide range of indications with a low risk of complication and reoccurrence.

Nonsurgical Creation of an Auriculocephalic Sulcus in Children With Congenital Auricular Deformities.

Nonsurgical correction of congenital auricular deformity is known to be effective in newborns. In this study, the authors investigated factors influencing the outcome of nonsurgical or surgical correction of the auriculocephalic sulcus, an important auricular structure and one that is necessary for wearing glasses or a mask. A total of 80 ears (63 children) were splinted using a metallic paper clip and thermoplastic resin in our outpatient clinic between October 2010 and September 2019. The ears were divided into a group, in which the auriculocephalic sulcus was formed nonsurgically (n =5 6) and a group, in which surgery was needed (n = 24). The authors compared the clinical characteristics of the deformities, whether cryptotia affected the superior or inferior crus, and whether constricted ears were Tanzer group IIA or IIB between the two study groups by retrospective chart review. There was a significant correlation between the age, at which ear-molding treatment was initiated and outcome ( P < 0.001). The optimal cutoff value for age, before which ear-molding treatment should be initiated was 7 months. Inferior crus-type cryptotia was corrected adequately by splinting, but all Tanzer group IIB constricted ears needed surgical treatment. Earlier initiation of ear-molding treatment is recommended, preferably before 6 months of age. Nonsurgical treatment is an effective intervention for the creation of the auriculocephalic sulcus in ears with cryptotia and Tanzer group IIA constricted ears but cannot correct for an inadequate amount of skin over the auricular margin or a defect in the antihelix.

Modified bilateral fasciaperichondrial flap for prominent ear correction.

OBJECTIVE: Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures. METHODS: Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures. RESULTS: Between May 2017 and May 2021, 32 ears of 17 patients were operated on due to prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ±â€¯0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values. CONCLUSION: A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction. LEVEL OF EVIDENCE: III.

Cryptotia Repair Using a Modified V-Y Advancement Flap with Helix Rounding Technique.

BACKGROUND: Cryptotia is a common congenital auricular malformation seen in Asian people. To date, multiple surgical procedures have been described for correcting cryptotia. However, the deformity often recurs, presenting as an unclear auriculotemporal sulcus and a malformed helix. The present study aimed to introduce a novel surgical approach to obtain a stable and aesthetic auricular correction in cryptotia patients and to acquire an understanding toward improved surgical management of cryptotia. METHODS: Twenty-four cryptotia patients (28 ears), who were operated between April 2018 and November 2021, were included in this study. All patients underwent surgical correction for cryptotia using a modified V-Y advancement flap with helix rounding technique, performed by a senior surgeon. RESULTS: Patients were followed for an average period of 9.4 months (6 to 18 months). Twenty-one patients (87.5%) were satisfied, three (12.5%) were partially satisfied, and none were unsatisfied. Most patients experienced temporary edema as a postsurgical complication, which resulted in a swollen auricle appearance lasting for three to four weeks postoperatively. One patient experienced skin necrosis in one ear on the anterior portion of the upper helix and this was solved by skin grafting. CONCLUSIONS: The method of surgical correction utilizing a modified V-Y advancement flap with helix rounding technique proved to be a reliable option in cryptotia patients. It can provide stable aesthetic results after cryptotia correction in clinical practice. 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 .

One-Year Outcomes of Ear Molding for Infants with Constricted Ear.

BACKGROUND: Ear molding is a noninvasive treatment that shows promising results for neonatal ear deformations. Little research has been reported evaluating 1-year outcomes or relapse after ear molding for ear malformations. METHODS: One-year molding efficacy for constricted ear, a common malformation that affects the aesthetic appearance of the auricle, was assessed during a single-center, prospective study conducted over a 3-year period (from May of 2017 to April of 2020). Infants with constricted ears were recruited and treated with the EarWell Infant Ear Correction System. Constricted ear classification, age at treatment application, duration of treatment, complications, and parental satisfaction were analyzed. Photographic documentation of the ears was performed before treatment, at treatment termination, and 12 months after treatment to evaluate treatment efficacy and relapse. RESULTS: Sixty patients with 91 constricted ears were recruited. The EarWell Infant Ear Correction System was initiated before 2 weeks of age for 75.0% of these patients. Successful correction was achieved in 85.8% of patients. Early molding initiation (before 14 days of age) resulted in a significantly higher success rate ( P = 0.017). Class 1 and class 2 deformities achieved better outcomes than class 3 deformities ( P = 0.001). Among the 91 auricles, 37 ears (40.7%) relapsed: 36.3% had mild relapse, 4.4% had moderate relapse, and 0% had severe relapse. The treatment duration for patients with relapse was shorter than for patients without relapse ( P = 0.035). CONCLUSION: Early ear molding is an effective treatment for constricted ear. Sufficient molding duration and consolidation periods are crucial in maintaining treatment effects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Study on Application of YAG Laser-Assisted Ear Correction Model to Congenital Auricular Deformities.

BACKGROUND: The objective of this study was to compare the clinical effects of a long-pulse-width 1064-nm Nd:YAG laser-assisted ear correction model and a simple ear correction model in the treatment of congenital auricular deformities in children older than 6 weeks. METHODS: A total of 129 children (179 ears) with congenital auricular deformities who were older than 2 months were included. Among them, 84 (119 ears) were treated with the ear correction model after long-pulse-width 1064-nm Nd:YAG laser irradiation (observation group) and 45 (60 ears) were treated with the ear correction model only (control group). The affected ears of the two groups were measured, the correction time was calculated, and the patients' family members filled in the satisfaction questionnaire before and after the treatment. RESULTS: The level of satisfaction of both groups improved after the treatment. The satisfaction level of the observation group was higher than that of the control group. Fewer days of correction were observed in the observation group than in the control group ( p < 0.05). The measurements of the affected ears in the two groups were significantly different after treatment. The difference after treatment of each measurement in the observation group was higher than in the control group. The therapeutic effect of the observation group was significantly better than that of the control group and the differences were statistically significant. CONCLUSION: Long-pulse-width 1064-nm Nd:YAG laser combined with the ear correction model can improve the success rate of correction of congenital auricular deformities in over-aged ears. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

External ear anatomy and variations in neonates.

It is aesthetically important that the auricle has a natural and beautiful shape. The sizes, position and symmetry of normal auricle are used for different purposes in different disciplines. A deformation in the auricle of neonates and its size or location on the face may indicate a possible anomaly. The aim of this study is to investigate the normal sizes, anomaly types, anomaly rates and the relationship between hearing screening test results and auricular anomaly of the neonatal auricle. The length, width, angle, and distance measurements of the auricle were made in neonates (n = 550). Anomaly types of auricle were observed. Goniometer was used to measure angles; digital caliper and ruler were used to measure lengths. Anomalies were detected by the method of observation. In the morphometric data of the neonatal auricle, differences were determined in length and width values in terms of gender. Various types of anomalies were observed in the right ear of 96 participants and in the left ear of 103 participants. Normal auricle size, position and symmetry are important for surgical reconstructions, hearing aid design, producing data banks on gender, age and ethnicity, and providing reference information for multiple diagnostic and forensic procedures. Recognition and early detection of auricular anomalies play an essential role in clinical diagnosis and their correction with special devices.

Noninvasive ear molding in the correction of ear anomalies: A systematic review and meta-analysis.

OBJECTIVE: Ear molding has been used for the treatment of congenital external ear anomalies. The purpose of this study is to systematically review ear molding therapy and perform a meta-analysis to determine its efficacy. METHODS: A systematic review and meta-analysis of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed and Embase databases from January 2009 to April 2021 were searched. Individual studies were eligible for inclusion if they evaluated noninvasive ear molding for congenital ear anomalies, featured at least 50 ears, and were published in English. RESULTS: 15 studies (one RCT and 14 clinical series) with a total of 1729 children undergoing molding of 2508 ears were identified and included in the meta-analysis. Meta-analysis of the eight studies with reported success rates as determined by clinician assessment showed an overall success rate in 87.4% of ears. Meta-analysis of the three studies with reported efficacy as assessed by laypersons showed an overall success rate of 92%. All studies reported a variety of minor skin-related complications in the ear, such as eczema, excoriation, infection, irritation, rash (allergic or nonallergic), and ulceration. Generally, complications were not reported to be serious and were noted to resolve with minimal to no intervention. CONCLUSION: To the authors' knowledge, this study represents the largest modern systematic review and meta-analysis analyzing the efficacy of ear molding. A review of the 15 studies included suggests that ear molding is an effective and safe treatment for congenital ear anomalies with a high success rate. However, the strength of this body of evidence is reduced by a lack of comparative studies, heterogeneous patient populations, treatment protocols, and ear assessment scales.

["Tragus flap" combined with "Z" modification method in the surgical correction of congenital tragal deformity in children and literature review].

Objective:To explore the clinical effect of "tragus flap" combined with "Z" modification method in the surgical correction of congenital tragal deformity in children. Methods:The clinical data of 36 children with congenital tragal deformity who were operated in Children's Hospital of Nanjing Medical University from June 2016 to June 2021 were retrospectively summarized, 30 children（35 ears）with congenital tragal malformation had a natural "tragus flap" structure. During the operation, "tragus flap" combined with "Z" modification method was used to reconstruct the tragus. For the depressed deformity around the tragus, the cartilage and fascia tissue around the tragus were used for filling.In the other 6 cases （8 ears）, because the natural "tragus flap" structure was not found, the tragus was reconstructed by other methods, and a relatively satisfactory tragus structure was obtained. The overall effect was satisfactory. Results:No obvious complications were observed during and after the operation. No obvious scar and cartilage hyperplasia were found during the follow-up of 1-12 months. The reconstructed tragus has a good three-dimensional shape, and the depression at the tragus has been well corrected, which is close to the healthy side. The children with bilateral tragus deformity basically achieve bilateral symmetrical tragus, which is satisfactory to the children and their parents. Conclusion:Although the clinical manifestations of congenital tragal malformation are various， "tragus flap" combined with "Z" modification method for tragus reconstruction can be used for most cases. The method not only has shorter operation time, less skin scar and fewer complications, but also can obtain more natural tragus structure.

Performance-optimized otoplasty.

OBJECTIVES: This study proposes a new surgical alternative for the most common deformity in the ears, the so-called "protruding/prominent ears", which is a condition that affects 5% of the Caucasian population (Goulart et al. in Rev Bras Cir Plast 26:602-607, 2011). This technique comes with the benefits of reduced surgical time, shallow learning curve, and a low revision rate. METHODS: We studied a total of 213 patients with an indication for otoplasty from January 2020 to January 2021. Women made up 65% of the study population, while men made up 35%, with an average age of 21 years, the youngest being 7 years of age. The technique presented here corrects all the deformities that cause protruding ears and can be performed together with other ear surgeries, such as surgical treatment of macrotia and lobuloplasty. All surgeries were performed in an outpatient setting under local anesthesia and sedation. RESULTS: All surgeries followed a performance-optimized protocol, with an average total surgical time of 45 min for a bilateral approach. Revision surgery was needed in 2% of cases, with the most frequent complaint being asymmetry in the upper third of the ears. The complication rate was approximately 7.5%, with 1 case of hematoma, 1 case of mild infection, 2 cases of altered ear sensitivity, 3 cases of keloid scar formation, 6 cases of asymmetry in the upper third of the ears, and 3 cases of irregularities or spikes in the antihelix cartilage. Patient satisfaction was measured using the McDowell/Wright Objectives and Outcome Index (McDowell in Plast Reconstr Surg 41:17-27). CONCLUSION: The proposed performance technique is a viable alternative to optimize the surgical time of otoplasty in an outpatient setting. This technique can be performed together with other corrective ear surgeries, has a shallow learning curve, and has a low revision rate. LEVEL IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.

Tragal remnant flap reconstruction method for congenital tragal malformation in children.

OBJECTIVE: To explore the clinical effect of tragal remnant flap for congenital tragal malformation in children. METHODS: The clinical data of 23 children with congenital tragal malformation hospitalized in our department from May 2017 to May 2021 were retrospectively reviewed. RESULTS: Congenital tragal malformation has various names and clinical manifestations. It is a kind of rare congenital auricle malformation, which can exist alone or in combination with other malformations. About 78.3% of the children with congenital tragal malformation had a natural tragal remnant flap; The rest of the children without tragal remnant flap were repaired by skin flap＆cartilage reconstruction method (SFC-RM). For the depressed deformity around the tragus, the cartilage and fascia tissue around the tragus were used for filling. The overall effect was satisfactory. CONCLUSIONS: Most children with congenital tragal malformation have natural tragal remnant flap. Tragal remnant flap reconstruction method (TRE-RM) not only has shorter operation time, less trauma, faster healing，fewer complications, but also can obtain more natural tragus appearance.

[Nonsurgical correction of cryptotia in children older than early neonates].

Objective:To study the clinical application of nonsurgical correction of cryptotia in children older than 6 months. Methods:The children with cryptotia deformity treated in Guangzhou Women and Children's Medical Center from January 2017 to January 2021 were divided into two groups according to their ages. The study group was over 6 months old and the control group was under 6 months old. They were treated with a Earwell auricle correction system, the follow-up was continued for 3-6 months, and the correction effects, complications and recurrence after the treatment were calculated in the two groups. Results:The average time of the treatment start stage and consolidation stage in the study group was（20.29±7.14） days and（31.82±9.65） days, and respectively the control group was（7.5±3.21） days and（16.64±6.53） days, the difference in treatment time between the two groups was statistically significant（P=0.001）. The effective rate in the study group was 90.91%（20/22）, and the effective rate in the control group was 96.43%（27/28）, there was no statistically significant difference between the two groups（P=0.576）. The recovery rate in the study group was 31.82%（7/22）, and the recovery rate in the control group was 85.71%（24/28）, the cure rate of the control group was higher than that of the study group（P=0.002）. Complications occurred in both groups. The most common complications in the study group were skin redness and swelling 18 cases（81.82%） and stent shedding 16 cases（72.73%）, pressure ulcers followed by 12 cases（54.55%）. The most common complication in the control group was skin eczema 9 cases（32.14%）, pressure ulcers 6 cases（21.43%）, stent shedding 5 cases（17.86%）. There was a statistical difference in the incidence of complications between the two groups（P<0.05）. Conclusion:For older children with cryptotia, Earwell correction systems can still be actively tried to correct hidden ears, but only the hidden auricle can be pulled out. Other combined malformations such as helix adhesion, dysplasia of the upper helix, etc. cannot be improved. Before treatment, it is necessary to fully communicate with the parents about possible complications during the treatment process. Encouraging children and parents to insist on wearing the correction system is the key to successful treatment.

Classification and Surgical Strategies of Constricted Ears in a Chinese Specialty Clinic: A Retrospective Study.

BACKGROUND: The constricted ear is an auricular deformity produced by a deficiency in the circumference of the helical rim. The classification and corrective methods for constricted ears continue to be controversial. In order to identify them, the authors have reviewed and analyzed cases operated in a Chinese specialty clinic. METHODS: Correction of constricted ears from January of 2017 to June of 2021 was retrospect through medical records. Data of patients' variables (including sex, age, laterality, type of constricted ear, presence of other ear anomalies), surgical techniques, esthetic outcomes, and postoperative complications have been collected. RESULTS: The deformed ears were classified into four graded types by three criteria including deficiency of auricle cartilage, vertical height in dorsal view, and surgical outcome. A total of 68 constricted ears of 57 patients (type I, n = 6; type IIA, n = 41; type IIB, n = 19, and type III, n = 2) were enrolled in the study. Of the 66 constricted ears undergoing surgical correction, most of them were performed with helical expansion through auricular/costal cartilage graft, Mustardé-type mattress sutures, and tumbling cartilage flap. External molding using Vaseline gauze rolls was implemented on every case to assist reshaping the scapha. A triangular superficial temporal fascial flap was elevated to prevent the reoccurrence of lidding in some cases. Corrective techniques and esthetic outcomes for deformed cases of each graded type were described. Based on a four-point Likert scale, the average esthetic outcome score was 3.7. CONCLUSIONS: The classification was practical and the constricted ears were effectively corrected by simple surgical procedures without removal of deformed auricular cartilage. All corrections were performed in one stage. 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 .