New Method Using Local Affected Cartilage and Flap for the Cleft in Question Mark Ear.

BACKGROUND: As a rare auricular deformity, despite numerous surgical procedures for correcting moderate-to-severe question mark ears described in past studies, there remains a need to explore a more cost-effective approach. The optimal utilization of ear cartilage and surrounding skin while achieving superior outcomes continues to pose a significant challenge. METHODS: From 2018 to 2023, twenty-four patients with unilateral question mark ear were enrolled in this study. Seven of them were severe type deformities (absence of lower part of auricle), and seventeen were moderate (only cleft between helix and lobule). All patients were treated with new method using local cartilage and flap without damage in unaffected area. RESULTS: All patients were satisfied with significant improvement of question mark ear and the overall symmetrical appearance. The surgical scar was not obvious. No complications were observed. The follow-up period revealed that the corrective procedure kept producing the symmetrical and cosmetic results. CONCLUSION: Our new method enables optimal utilization of deformed tissue and surrounding skin, rendering this method effective and reliable for correcting moderate-to-severe question mark ears. 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 .

The advantages of domestic ear molding system in molding bilateral neonatal congenital auricular deformities.

BACKGROUND: There are different types of ear molding devices on the market. However, due to high cost, the wide application of the ear molding is hindered, especially for children with bilateral congenital auricular deformities (CAD). This study is designed to correct the bilateral CAD with the flexible use of Chinese domestic ear molding system. METHODS: Newborns diagnosed with bilateral CAD were recruited in our hospital from September 2020 to October 2021. For each subject, one ear wore a set of domestic ear molding system, while the contralateral ear used only matching Retractor and Antihelix Former. Medical charts were reviewed to collect data on the types of CAD, the incidence of complications, the initiation and duration of treatment, as well as the satisfaction after treatment. Treatment outcomes were graded into three levels: excellent, good, and poor, according to the improvement of auricular morphology evaluated by both doctors and parents, respectively. RESULTS: A total of 16 infants (32 ears) were treated with the Chinese domestic ear molding system, which contains 4 cases with Stahl's ear (8 ears), 5 cases with Helical rim deformity (10 ears), 3 cases with Cup ear (6 ears), 4 cases with Lop ear (8 ears). All infants accomplished the correction completely. Both parents and doctors were satisfied with the outcomes. No obvious complication was observed. CONCLUSIONS: Ear molding is an effective nonsurgical treatment for CAD. Molding with Retractor and Antihelix Former is simple and effective. Domestic ear molding system can be flexibly used in correcting bilateral CAD. With this approach, infants with bilateral CAD will benefit more in the near future.

Ear Molding in Children-Timing, Technique, and Follow-up: A Systematic Review.

Background: Nonsurgical management of congenital ear anomalies using molding devices shows efficacy but lacks standardization of treatment protocols and outcome measures. Learning Objective: To compare ear molding techniques and identify factors related to treatment outcomes. Design Type: Systematic review of the literature (1990-2021). Methods: Studies reporting molding for congenital ear anomalies were assessed. PRISMA guidelines were used. Data extracted included: age at treatment initiation, treatment duration, correction rates, and complications. Data analysis included descriptive statistics and outcomes were compared using the Student t-test. Results: In total, 37 studies with 3,341 patients (mean patients per study, 95; range, 5-488) were included. Infants in whom treatment was initiated at 4.8 weeks (median, 3.7; range, 0.9-8.8 weeks) were treated for 5.1 weeks (median 4.7, range 2.6-7.6 weeks) with 11.0 months follow-up (median 11.4, range 1.4-21.0 months). Individualized devices (physician-customized) were used more (62.2% of studies) than commercial devices. No difference in correction (p = 0.44) or complication rates (p = 0.19) was identified between devices. Totally, 70.3% of studies reported complications and 40.5% of studies included long-term follow-up data. Conclusions: The available evidence supports initiating ear molding in the first weeks of life to be most effective, yet outcome data should be standardized in future studies to improve evidence quality.

[Therapeutic effect analysis of non-invasive ear moldings on correcting congenital auricular deformity in 435 ears].

Objective:To evaluate the therapeutic effect of non-invasive ear moldings on correcting congenital auricular deformity of infants. Methods:A total of 435 ears with congenital auricular deformity were treated in the department of Otorhinolaryngology of Chengdu Women and Children's Central Hospital from December 2019 to July 2023. The infants were divided into 3 groups according to the initial treatment age, i. e. , 0-30 days（group A, n=106, 175 ears）, 31-90 days（group B, n=124, 202 ears） and ≥91 days（group C, n=37, 58 ears）. All infants were corrected with Chinese ear moldings. The efficacy, complication rate and treatment duration were compared among the three groups, and the treatments of different types of auricle deformity was analyzed. Results:Through comparison of three groups, the results showed that the markedly effective and cured rate of group A was the highest, and group C was the lowest. The difference was statistically significant（P=0.008）. Specially, there was a significant decrease of after 5 months in Group C. There was no significant difference in the complication rate among the three groups（P=0.232）, and the occurrence of complications has no significant impact on treatment. Group C has the longest treatment duration and group A has the shortest. The difference was statistically significant（P<0.001）. Conclusion:Congenital auricle deformity should be early detected and intervened. The younger the age of children, the better efficacy and shorter treatment duration can be acquired. Children under 5 months still will receive a good treatment. Nevertheless, for children older than 5 months, corrective treatment may also be considered. The efficacy for malformations was significantly lower than that of deformations. The number of cases, efficacy and complication rate for different types of deformations were significantly different.

The application of the strip-shaped cymba conchae orthosis in the nonsurgical correction of complex auricular deformity.

Objective: This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities. Methods: Clinical data were collected from 2020 to 2021 for 6 patients who underwent correction using a strip-shaped cymba conchae orthosis. The indications, corrective effects, and complications associated with use of the orthosis were analyzed. Results: There were four indications for treatment: cryptotia with helix adhesion; cryptotia with grade I microtia; cryptotia with excessive helix thickness; and auricular deformity beyond the treatment time window (≥6 months). Excellent corrective effects were observed in all 6 patients. Complications occurred in one patient, who recovered after symptomatic treatment. Conclusion: The use of a strip-shaped cymba conchae orthosis alone or combined with a U-shaped helix orthosis presents a feasible approach for correcting complex auricular deformities or deformities beyond the treatment time window in pediatric patients.

Single-stage reconstruction of severe question mark ear with the absence of large portions of the lobule using affected cartilage graft and 3 flaps.

BACKGROUND: Question mark ear (QME) is a congenital abnormality characterized by a prominent curve within the helix that resembles a question mark. Several surgical reconstruction techniques have been proposed to treat this deformity. In this study, we aimed to evaluate the cosmetic outcomes of a new cartilage and postauricular flap surgical reconstruction technique for patients diagnosed with severe QME. METHOD: From 2017 to 2023, 33 patients with severe QMEs were treated with a new reconstruction surgical technique at the Plastic Surgery Hospital of Peking Union Medical College. The perimeter, width, length, and auriculocephalic angles of both ears were measured and compared to assess the symmetry. The patient's satisfaction with the surgical outcomes and incidence of post-operative complications were also evaluated. The average follow-up duration was 15.48 months. RESULTS: The auricular perimeter, width, and length changed significantly after surgery. The dimensions of the left and right ear did not vary significantly in patients with unilateral or bilateral severe QME after surgery and at the end of the 1-year follow-up. Most patients (87.88%) or carers were satisfied with the cosmetic outcomes after surgery. All patients underwent suture removal 14 days after surgery and exhibited excellent wound healing without any complications such as hematoma, infection, and flap necrosis. CONCLUSION: Our new surgical reconstruction technique for severe QME resulted in good cosmetic outcomes, high patient satisfaction, fast recovery, and no post-operative complications.

Auricular deformity correction with simultaneous reconstruction of the conchal bowl using autologous ear cartilage for "flat ear": A novel surgical technique.

BACKGROUNDS: "Flat ear" is a subtype of Grade II conchal-type microtia characterized by severely underdeveloped conchal bowl. Traditional surgical techniques often rely on autologous costal cartilage, which poses several risks and complications. This study aimed to introduce a novel surgical technique using autologous ear cartilage in auricular deformity correction surgery with simultaneous conchal bowl reconstruction for "flat ear." METHODS: A total of 19 patients were involved in this single-center, retrospective cohort study. All patients underwent the described surgical technique. Data were collected preoperatively, immediately after the surgery, and at the last follow-up, including auricular length, width, perimeter, and conchal bowl depth. Patient satisfaction was assessed using the Visual Analog Scale (VAS). RESULTS: The study included 12 males and 7 females, with an average age of 10.67 ± 3.86 years. Postoperative results showed significant improvements in auricular measurements, with the affected ear achieving near symmetry with the normal ear. The mean conchal bowl depth was restored from a preoperative 4.33 ± 1.78 mm to 17.32 ± 1.28 mm postoperatively. VAS scores for patient satisfaction increased significantly from 1.44 ± 0.92 preoperatively to 7.72 ± 1.49 postoperatively, with stability observed at the last follow-up. CONCLUSION: The novel technique offers a promising alternative to traditional costal cartilage-based auricular deformity correction surgery, providing excellent aesthetic outcomes and high patient satisfaction. This approach may expand treatment options for patients with "flat ear" and related auricular deformities, with reduced invasiveness and potential for future auditory rehabilitation.

Ear Molding for Congenital Auricular Deformities: Efficacy and Factors Affecting Outcomes.

Objective: This study's aim was to assess the effectiveness of ear molding for congenital auricular deformities, analyze the factors affecting prognosis, and provide more clinical data supporting nonsurgical correction for this condition. Methods: A prospective study of a consecutive series of infants treated with ear molding from January 2021 to December 2022 in the department of otolaryngology, Second Affiliated Hospital of Harbin Medical University, was conducted. Demographic and clinical information were collected, and photographs of the ear were taken before and after treatment. Treatment efficacy and the relevant influencing factors were evaluated. Results: Thirty-five patients, including 59 with congenital ear anomalies, underwent noninvasive ear molding. The deformity type, treatment initiation age, and number of treatment cycles affected treatment efficacy. Earlier treatment initiation was associated with a shorter treatment period. Treatments were started earlier if decision-makers were more anxious. Conclusion: The earlier the neonatal auricle deformity is treated, the shorter the treatment time and the more ideal the clinical effect will be. Early noninvasive treatment for microtia is valuable. Early detection and parental awareness and education can help children receive treatment earlier and improve the success rate.

Characteristics of 43 multiple auricular deformity case families and auricle morphology in 463 microtia patients in South China.

BACKGROUND: Earlier studies have suggested that microtia is a genetic disease with a worldwide incidence of microtia is between 0.83/10,000 and 17.40/10,000. For microtia, auricle morphology is the most crucial characteristic. However, no studies have been performed to characterize the genetic similarity of microtia and auricle morphology similarity. For the sporadic patients, the relationship between the gestational age of parents and the incidence of microtia is unclear. To obtain the characteristics of auricular deformity multiple case family (AD-MCF) and clarify the relationship between genetic similarity and auricle morphology similarity in AD-MCF. METHODS: This study included 463 AD patients who were diagnosed by Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from 2013 to 2019. Among these patients, 116 are from 43 MCF and the other 347 patients are sporadic. For the patients from families, the disease status of the four generations of immediate family members and the family tree map were collected to analyze the similarity of auricle shape in family members. A score evaluated the similarity of auricle shape according to the structure of the residual ear and the similarity in the morphology of each auricle. Moreover, the population distribution of AD and the gestational age of patients were further analyzed. RESULTS: From 2013 to 2019, a total of 463 patients were diagnosed as microtia in our hospital. There were 427 patients with unilateral disease and 36 patients with bilateral disease. Among them, 116 patients were from 34 families and 9 de novo families. The total scores of patients in different genetic difference levels were compared and were found significantly different (P<0.001). Moreover, 58.14% of families were consistent with the law of chromosomal recessive genetic diseases. Importantly, we found that the gestational age of father in microtia de novo families is 30.94±0.75, and mother in de novo is 28.39±0.73 that is significantly higher than the gestational ages of parents from microtia families with P value =0.0001. CONCLUSIONS: The auricle similarity between family members is positively related to the genetic distance between family members. The microtia patients are potentially associated with the gestational ages of parents.

Anthropometric research of congenital auricular deformities for newborns.

Objective: This study aimed to get the data of Neonatal auricle for helping pediatricians and obstetricians to make definite diagnosis and individualized treatment for newborn congenital auricular deformities in China. Methods: A total of 1500 newborns' ears were evaluated in this study. Six surface measurements were performed directly on the auricles of the subjects as follows: physiognomic ear length and breadth, morphological ear length and breadth, cephalo-auricular distance, and cephalo otic angle. Results: The incidence of neonatal auricular deformities in the Pearl River Delta area was 57.47% and the self-healing rate was 31.61% by the 30-day follow-up. There were significant differences between different types of auricular deformities (protruding ear, cup ear, lop ear, Stahl's ear, conchal crus, helical rim deformity, and composite deformity) and normal morphological differences of the auricle. Conclusions: Our findings suggested that individual differences in ear morphology are large and there were some differences between measurement data in our study and EarWell. Application of the EarWell system may lead to localized skin excoriations or breakdown as a result of mismatch with the ear. Therefore, early use of personalized ear molds produced by three-dimensional printing to determine if more deformed auricles may be corrected.

[Rapeutic effect analysis of the auricle appliance on 2-6 months old infants with congenital auricle deformity].

Objective: To study the effect of amazing ear correction system on 2-6 months old infants with congenital ear deformity. Method: Thirty infants (37 ears) with congenital auricular deformities were enrolled in the study. Deformities included constriction, cryptopia, helicalrim, prominent, conchal strut, and Stahl deformities and microtia. The patients were divided into 2 groups. Infants elder than 2 months were 20 cases(26 auricular malformed ears). And infants under 2 months old were 10 cases(11 auricular malformed ears). All the patients underwent ear molding using the amazing ears correction system. The patients of each group were followed-up for at least 3 months. Result: The results were divided into three levels(excellent, good, and poor) according to the correction of auricular shape. In Group elder than 2 months, 13 ears were excellent and the average treatment time was 46.85 days，5 ears were good, the average treatment time was 43.40 days and 8 ears were poor, the average treatment time was 13.13 days. In Group under 2 months old, 5 ears were excellent and the average treatment time was 28.80 days，6 ears were good and the average treatment time was 18.66 days. The patients of each group were followed-up for at least 3 months and no rebound occurred. Conclusion:Ear correction system has a significant effect on those more than 2 months and less than 6 months with congenital auricular deformity. The children who were more than 2 months old need to wear the auricle appliance over 6 weeks to achieve a satisfactory effect.

[Study on the recent application of ear correction model in children with congenital auricular deformity].

Objective:To study the short-term effect of Earwell ear correction model on congenital auricular deformity in children. Method:Selected 38 children with ear malformation, a total of 42 ears, born at the age of 7 days to 176 days, and the average age was 62.40 days, and all of patients were used the U.S. Earwell correction model for correction. Result:Final auricular morphologic results were classified as excellent (normal shape), good (nearnormal shape), and poor (slight or no improvement). And the patients were divided into group 1 (neonatal period), group 2 (28-90 days) and group 3 (more than 90 days) according to age, after using the Earwell ear correction device, the result which evaluated excellent are 100.00%, 89.47% and 72.73% respectively, and the average correction times are 16.75 days, 26.26 days and 38.91 days respectively, the ratio of complications are 0, 73.68% and 100.00% respectively. Conclusion:The effection of Earwell ear correction model is significant for the correction of children with congenital auricular deformity , the earlier treatment cause the better result, the shorter of the correcting time , and the lower of the complication rate.

Surgical correction of constricted ear combined with Stahl's ear.

Constricted ear combined with Stahl's ear is a rare ear deformity, which is a kind of complex congenital auricular deformity. From 1 January 2007 to 1 January 2014, 19 patients with constricted ear combined with Stahl's ear (Spock ear) were enrolled in this study, most of which were unilaterally deformed. To correct the deformity, a double Z-shaped skin incision was made on the posterior side of the auricle, with the entire layer of cartilage cut parallel to the helix traversing the third crus to form a fan-shaped cartilage flap. The superior crura of the antihelix were shaped by the folding cartilage rim. The cartilage of the abnormal third crus was made part of the new superior crura of antihelix, and the third crus was eliminated. The postoperative aesthetic assessment of the reshaped auricle was graded by both doctors and patients (or their parents). Out of the 19 patients, the number of satisfying cases of the symmetry, helix stretch, elimination of the third crus, the cranioauricular angle, and the substructure of the reshaped ears was 14 (nine excellent and five good), 16 (six excellent and 10 good), 17 (eight excellent and nine good), 15 (five excellent and 10 good), and 13 (two excellent and 11 good), respectively. With a maximum of a 90-month follow-up, no complication was observed. The results of the study suggested that this rare deformity could be corrected by appropriate surgical treatment, with a satisfied postoperative appearance.

Microtia reconstruction: autologous rib and alloplast techniques.

Microtia represents a spectrum of maldevelopment of the external ear. Reconstructive techniques may utilize an autogenous rib cartilage framework and require 2-4 stages; alternatively, an alloplastic framework can be used and typically requires 1-2 stages. Successful reconstruction of microtia with either technique can provide a significant quality of life improvement, and both techniques are described in this article.

Pediatric esthetic otoplasty.

Pediatric otoplasty is generally considered to be a "simple" procedure, but an astute surgeon recognizes the challenges of this operation and is mindful of the degree of detail involved in its planning and execution. The vast number of described otoplasty methods, which are ever evolving, is a testament to the complexity of this procedure. In this article, the authors' methodology with respect to preoperative analysis and planning, surgical technique, and postoperative care, including management of complications and potential pitfalls, are highlighted.

Our preferred surgical approach to cicatricial cryptotia.

BACKGROUND: Adhesions between the auricle and retroauricular cranial wall and mastoid occur after burns to this area due to cicatricial contracture, leading to the distortion of the otocranial angle and obscuring the remnant auricle in the scar. A definition of cicatricial cryptotia was devised to describe the ear deformity after burn by the authors, and a novel surgical approach to cicatricial cryptotia was employed to reconstruct the auricle. PATIENTS AND METHODS: A total of 33 ears in 26 adult patients were operated upon. As many as 19 cases of cicatricial cryptotia were unilateral, seven cases bilateral. The patients' age ranged from 19 to 31 years. Because of a lack of normal tissues surrounding the remnant ear, a periauricular cicatricial flap was designed to repair the helix and antihelix defect and a horizontal bifoliate skin flap for earlobe reconstruction. Two triangular cicatricial flaps located at the cephalic or caudal direction of the survival ear were used for shaping the otocranial angle and auriculotemporal sulci, combined with zoned transplantation of a full-thickness skin graft. RESULTS: All cicatricial flaps demonstrated nearly 100% survival and the take rate of transplanted skin grafts was approximately 95%. The main structures were visible and cosmetically acceptable; the otocranial angle and auriculotemporal sulci were acceptably restored. The function of wearing eye glasses or a mask was regained. The patients were followed up from 3 months to 6 years after surgery; the mean follow-up period was 3.2 years. The contour of the reconstructed auricle was maintained well, and the scar contracture was acceptable. CONCLUSION: Periauricular cicatricial flaps combined with skin grafting is a new approach to cicatricial cryptotia when auricle reconstruction after burn is limited by a scarcity of supple, elastic local skin and fascia.

Helical rim reconstruction using two bi-pedicled tube flaps.

Thermal injury can result in substantial auricular deformity and subsequent psychosocial morbidity. Helical rim repair, in particular, poses formidable challenges to the reconstructive surgeon. Bi-pedicled tube flaps are one option that have the potential to restore much of the helix's natural contours. This case report discusses the unique strengths and weaknesses of the flap, as well as the reasoning that must be implemented when deciding which situations are appropriate for its utilization. Superior outcomes resulting in a high degree of patient and surgeon satisfaction are possible when the techniques of this report are employed appropriately.

Applicationof noninvasive correction of congenital auricle deformity / 实用医学杂志

Objective To investigate the application of noninvasive correction of congenital auricle defor-mity,and to analyze the cure rate and the causes of incidence of complications. Methods From January 2015 to December 2016,33 patients with unilateral or bilateral congenital auricle deformities were treated with non-surgi-cal correction technique in the Plastic Surgery Department of Guangzhou General Hospital. When the treatment was completed,the VAS score was used to assess the satisfaction of the patient's parents. Results From January 2015 to December 2016,33 patients(53 ears)received noninvasive treatment of the ear deformity correction system. The average age of the patients was(63.5 ± 41.3)days,the average treatment time was(41.6 ± 15.4)days,and the average parental satisfaction was 3.76 ± 0.93(total score:5 points). Significant difference was observedin auri-cle morphology data between pre- and post- treatment ,except for cranioauricular angle(P < 0.05). Conclusions In this study,the cure rate for non-surgical correction was good,however,the satisfaction of treatment decreased with age.The most common complication of treatment was auricle skin damage. The reasons of causing complica-tions maybe the age-induced reduction of ear cartilage elasticity which brought great pressure on the ear ,and the increase of the treatment time.

Treatment of Auricular Deformities with the EarWell System in Three Newborns

Auricular deformities occur frequently in newborn infants. Typically, most pediatricians explain to parents that these deformities will get better as child grows older. But, only about 30% of auricular deformities are known to be self-correcting, and there is no reliable model to predict them. If ear molding is initiated during the first days of life with the EarWell System, successful treatment could be possible without pain in a non-surgical way. We present 3 cases of auricular deformities treated with the EarWell System. 2 infants were born with auricular deformities at Gangnam Cha Medical Center and 1 infant visited the outpatient clinic for the treatment of auricular deformities. 5 ears in 3 infants underwent ear molding using the EarWell System. They had it placed on the 20th day after birth. Average treatment time was 18.7 days, and all of them were corrected. Complications were redness, oozing, erosion and mild pressure ulcerations. Early recognition and treatment of the auricular deformity ensure the great prospect of success. Also, it is important for both the parents and the pediatricians to know that auricular deformities could be successfully treated with Earwell System.

Prosthodontic rehabilitation of a patient with bilateral auricular deformity.

Maxillofacial prosthodontics is an art and science which provides life like appearance to the person with facial deformity. Maxillofacial prosthetic rehabilitation for acquired defects has become more complex and sophisticated with advancement in techniques and materials. This case report describes the clinical and laboratory procedure for fabricating an auricular prosthesis for a patient with trauma related bilateral auricular deformity. Ear prosthesis was fabricated in two parts taking retention from external auditory canal.