Anthropometric growth study of auricle of healthy preterm and term newborns

OBJECTIVE: Auricular abnormalities are important for early diagnosis of the birth defects in the prematures and newborns. Auricular antropometric studies in healthy premature and mature population depend on their gestational age are limited and insufficient. The aims of this study were to reveal antropometric growth and dynamics of the auricle in the healthy newborns from the 28th to the 42nd gestation weeks. MATERIALS AND METHODS: A total of 600 newborns were evaluated in 40 groups. Each group comprising 20 preterm or term newborns according to their sexes and gestational weeks. Six surface dimensions were performed directly from the right ears of the subjects: the length from the superaurale to subaurale, the width from the tragus to helix, the width from the tragus to antihelix, the conchal depth, the distance from the helix to mastoid at superaural level and the distance from the helix to mastoid at tragal level. The frequency of the prominent ear deformity and lobule attachment were also noted. RESULTS: The results of auricular antropometric measurements of healthy preterm and term newborns in different gestational weeks were to determined. No statistical differences of auricular length were found between male and female infants. The incidence of the prominent ear deformity and attached lobule was 8.16 and 27.4%, respectively. CONCLUSIONS: Normal anthropometric features for healthy newborns on the basis of gestational age are very important for the diagnosis of a variety of congenital malformations or syndromes. In this study, antropometric measurements of the auricle in the healthy preterm and term newborns on the basis of gestational age in our region were noted. Similar anthropometric studies in the preterm and term newborns at different geographic and various socioeconomic areas should be performed to constitute normative data in the literature.     

改良Brent法全耳再造术治疗先天性小耳畸形的临床分析

目的 探讨改良Brent法全耳再造术治疗先天性小耳畸形的临床效果及经验。方法 选取2018年11月—2021年4月湖南省儿童医院耳鼻咽喉头颈外科收治的用改良Brent法全耳再造术治疗先天性小耳畸形的患儿20例，患儿均为单侧耳畸形，年龄6.5~15岁，平均年龄8.7岁。一期手术首先处理残耳，分离耳后乳突区形成囊腔，同时行耳垂转位。取患耳对侧的肋软骨雕刻成耳廓支架，在传统雕刻的基础上，同时雕刻出耳屏，将耳屏处的基底垫高，尽可能的加深耳舟、三角窝，耳屏、耳屏间切迹的深度，在修剪耳轮时，将耳轮脚的前端尽可能垫高，尖端留置的更长，以凸显耳轮脚的深度。将耳廓支架埋置于耳后囊腔内;二期手术行"立耳"，颅耳角成形;三期手术行耳甲腔成形。结果 20例再造耳一期手术出现血肿1例，二期手术出现感染1例，支架外露1例，通过局部处理均恢复，并继续进行下一期手术。所有患儿三期手术术后随访3~9个月，再造耳双耳对称性佳，耳轮脚、耳屏处形态佳，颅耳沟加深，耳垂与耳廓下部接合处的线条流畅，再造耳总体外观满意。结论 改良Brent法全耳再造术，可更凸显耳屏、耳轮脚、三角窝及耳垂等部位的细微结构，更能呈现出再造耳的立体感，该方法可为先天性小耳畸形手术方式的选择提供参考。     

Anterior approach in otoplasty

Prominent ear deformity is an autosomal dominant inherited anomaly of the external ear. It's found to be affecting approximately 5% of the population. It most frequently results from two reasons, one being the poor developmental of the antihelix and the other being the overdevelopment of the conchal bowl. This condition can cause psychological problems in school-age children. One or more anatomical problems of prominent ear may be existing in the individuals. Several surgical methods were developed for these problems. More than 200 surgical techniques have been described up to date in otoplasty. These techniques are mostly focused on creating antihelix or on shaping the conchal bowl or the lobule. Anterior otoplasty that provides an easier and direct approach was discussed. In this technique, formation of the anti-helical fold by excision of a crescent shaped cartilage, if required, and by using subdermal pull sutures under direct visualization were discussed. Thus our technique enabled obtaining the new level of the conchal bowl ridge.     

The superiorly based auricular flap

A regional random pattern flap is described which may be used to cover the mastoid area in cases in which the inferior auricle and adjacent tissue have been removed by trauma or surgery. The viability of this vascularized tissue offers a distinct advantage over skin grafting when protection of exposed facial nerve and mastoid contents is required, especially when compromised by irradiation or infection. The superiorly based auricular flap is created by removing all cartilage from the auricular remnant. The resulting skin-perichondrial flap, covering the medial and lateral surfaces of the upper ear, is unfolded to cover the inferiorly located defect. The resulting cosmetic deformity, with loss of upper auricle contour, is a disadvantage of this flap which may be mitigated by the use of a prosthesis. After the superiorly based auricular flap is described, a case is presented.     

耳后带蒂皮瓣在修复耳甲腔皮肤缺损中的应用

目的介绍耳甲腔皮肤缺损中，应用耳后带蒂皮瓣修复耳甲腔皮肤缺损的方法及术后效果。方法2016年对耳甲腔良性肿物术后耳甲腔缺损的3例女性患者于耳后、乳突区，做一“乒乓球拍样”带蒂皮瓣，于耳廓根部做一隧道，将带蒂皮瓣从耳廓根部隧道穿过之后，覆盖于耳甲腔皮肤缺损处，缝合后加压包扎。结果3例患者耳后切口均Ⅰ期愈合，皮瓣颜色、质地、弹性均良好，耳甲腔外观良好，耳后供区瘢痕几乎难以察觉。结论耳后带蒂皮瓣在修复耳甲腔皮肤缺损中，简单易行，术后疗效佳，无论操作上还是美学上，都符合要求，值得临床推广应用。     

Evaluation of deformation after auricular cartilage collection

We studied the occurrence of deformation after collection of auricular cartilage. Subjects numbered 28 (15 with auricular cartilage collection and 12 without serving as a control group). We measured ear length, ear width, ear attachment length, auricular cartilage length, auricular lobe length, and auricle height, evaluating questionnaires given to subjects. Results showed that the collection of auricular cartilage does not result in deformation. In conclusion, the collection of auricular cartilage has few risks in view of cosmetics.     

Experimental investigations of the use of cartilage in tympanic membrane reconstruction

BACKGROUND: Temporalis fascia, perichondrium, and cartilage are commonly used for reconstruction of the tympanic membrane in middle ear surgery. Cartilage grafts offer the advantage of higher mechanical stability, particularly in cases of chronic tubal dysfunction, adhesive processes, or total defects of the tympanic membrane, in contrast to fascia and perichondrium, which presumably offer better acoustic quality. HYPOTHESIS: The purpose of this study was to determine the acoustic transfer characteristics of cartilage of varying thickness and its mechanical deformation when exposed to fluctuations in atmospheric pressure. METHOD: Ten pairs of cartilage specimens from the cavum conchae and the tragus were obtained from fresh human cadavers. Young's modulus was determined by mechanical tension tests and statistically evaluated using the t test. The acoustic transfer characteristics of an additional 10 specimens were measured by a laser Doppler Interferometer after stimulation with white noise in an external auditory canal--tympanic membrane model. Mechanical stability was determined by measuring displacement of the cartilage using static pressure loads of < or = 4 kPa. RESULTS: Young's modulus determinations for conchal and tragal cartilage were 3.4 N/mm2 and 2.8 N/mm2, respectively, but the difference was not significant. Acoustic testing showed a 5-dB higher vibration amplitude in the midfrequency range for conchal compared with tragal cartilage, but the difference was not significant. Reducing cartilage thickness led to an improvement of its acoustic transfer qualities, with a thickness < or = 500 microm resulting in an acceptable acoustic transfer loss compared with the tympanic membrane. CONCLUSION: Both conchal and tragal cartilage are useful for reconstruction of the tympanic membrane from the perspective of their acoustic properties. The acoustic transfer loss of cartilage can be reduced by decreasing its thickness. A thickness of 500 microm is regarded as a good compromise between sufficient mechanical stability and low acoustic transfer loss.     

四种方法耳屏再造术

目的探讨耳屏再造的四种手术方法,评价其优缺点及适应症。方法分别采用"M"形皮瓣法、带耳甲腔残迹的长方形皮瓣、耦合舌形皮瓣及副耳转移法等行耳屏再造术治疗耳屏缺损患者共64例。结果各种方法再造的耳屏外观均较为满意,且各有其适应症:"M"形皮瓣法适用于无耳屏且无耳甲腔患者;带耳甲腔残迹的长方形皮瓣法适用于无耳屏,但有凹陷性耳甲腔残迹者;耦合舌形皮瓣法适用于无耳甲腔或行外耳道再造术后耳甲腔上下边缘均存在多余组织者;副耳转移法适用于耳屏处存在副耳的患者。结论对于各种无耳屏的患者应根据局部的情况,因地制宜地采用不同的方法行耳屏再造,以求合理利用组织,再造出外观满意的耳屏。     

Cartilage-sparing otoplasty: our experience

Prominent ears are the most frequent congenital deformity in the head and neck area. Otoplasty has undergone important developments and numerous techniques have been employed to address the anatomical defects, namely the lack of antihelix and the overdevelopment of the concha. We present a cartilage-sparing technique involving scapha--conchal sutures insertion to recreate the antihelix, conchal setback and cartilage weakening. No cartilage is excised. Prior to creating the antihelix, the medial surface of the cartilage is superficially scored. Occasionally a tangential excision of the posterior prominence of the cartilage prior to the placement of set back sutures is employed for an excessively large conchal bowl. A series of 86 consecutive patients underwent otoplasty with this technique. According to our experience the described technique gives good and predictable long-term results with a natural-appearing ear. Significant complications are rare. In case of loss of correction, revisional surgery is straightforward on the intact pinna cartilage.     

Otoplasty for prominent ears in children. The technique adopted in the Portmann Institute

The Otoplasty technique adopted in the Portmann Institute is a simple rapid technique that maintains the natural contours of the auricle with minimal risk of infection. The technique involves excision of a large ellipse of skin from the mastoid surface of the auricle and reflection of remaining skin to the edge of the helix. The subcutaneous and muscular tissues on the mastoid bone are excised and the mastoid surface of the auricular cartilage scored with monopolar diathermy. After haemostasis, the wound is closed using continuous long-term absorbable sutures. A dressing and bandage are applied and the child is monitored for 10 days. A head bandage is applied at night for one month with use of a sun-screen cream on the scar at daytime.     

Aesthetic surgery for microtia

We describe here a technique for reconstruction of the external ear based upon an autogenous costal cartilage graft which is inserted into a cutaneous pocket dissected in the auricular area. Three subsequent procedures are then performed: rotation of the ear-lobe; reconstruction of the tragus; and elevation of the auricle. The ideal age for reconstruction is about 7 years. This technique was originally described by Brent, who has a very extensive experience with this kind of surgery. Skin deficiencies can be overcome by using either a temporo-parietal fascial flap or a skin expander.     

Aesthetic surgery for microtia

Summary We describe here a technique for reconstruction of the external ear based upon an autogenous costal cartilage graft which is inserted into a cutaneous pocket dissected in the auricular area. Three subsequent procedures are then performed: rotation of the ear-lobe; reconstruction of the tragus; and elevation of the auricle. The ideal age for reconstruction is about 7 years. This technique was originally described by Brent, who has a very extensive experience with this kind of surgery. Skin deficiencies can be overcome by using either a temporo-parietal fascial flap or a skin expander.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988     

Local control of auricular,periauricular, and external canal cutaneous malignancies with mohs surgery

Three hundred ninety-seven patients with 407 cutaneous malignancies of the auricle, periauricular region, and cartilaginous external ear canal were reviewed. Tumors were most commonly located in the preauricular and postauricu-lar regions, followed by the helix, concha, antihelix, and ear canal. All lesions were excised with Mohs microscopic control of margins. For lesions requiring lateral temporal bone resection, an adaptation of fresh-tissue microscopic control was used to analyze deep and anterior margins suspected of harboring residual tumor. Two-year minimum follow-up of 229 patients with periauricular and auricular tumors (N = 231 tumors) and 14 patients with cartilaginous ear canal tumors (N = 14 tumors) revealed recurrence rates of 6.9% and 14.3%, respectively. Recurrences were most common in cases of large tumors (>2.5 cm), basal cell carcinomas with morphea elements, and multiply recurrent lesions. We conclude that Mohs surgery is comparatively effective, though not uniformly curative, and can be adapted to supplement excision of large tumors in these regions.     

Posterior tragal perichondrium harvesting for myringoplasty

We present a modified harvesting approach for tragal perichondrium, used in tympanic membrane reconstruction. The technique described avoids amputation of the tragus thereby facilitating dissection of the perichondrium from the cartilage as compared to the traditional method. The approach described is technically easier, and removes any potential for cosmetic deformity associated with tragal cartilage amputation and reimplantation. Furthermore, both the anterior tragal perichondrium and the temporalis fascia remain intact if further surgery is required. We recommend this approach for permeatal, tragal perichondrial grafting of small to medium sized tympanic membrane perforations.     

Auricular repositioning otoplasty

The purpose of this paper is to introduce a new, safe and logical extension of the older concepts of otoplasty. The main principle involved here is complete undermining of all of the auricular cartilage above the isthmus cartilaginis auris by severing the three ligaments and the three muscles that connect the ear to the head. The entire auricular cartilage can then be repositioned at a normal angle in relation to the side of the head more readily than with previously used techniques. The external auditory meatus is easily enlarged if necessary. The sutures connecting the eminence of the scapha to the soft tissues of the mastoid posterior to the external auditory canal produce an antihelix whose contour is softer, wider and has more flowing curves. The wide area of excess skin removed provides a large area for cicatricial adhesions from the ear to the skull; additionally, in difficult cases this technique may be readily modified by any of the older established methods of otoplasty.     

A morphological study of age changes in adult human auricular cartilage with special emphasis on elastic fibers

OBJECTIVE: It is well known that the size of the human auricle increases after it has finished development. The reason why the size of the human auricle continues to enlarge until advanced age after reaching adulthood was investigated by observation of the ultrastructure of elastic fibers in human auricular cartilage. METHODS: A total of 1958 subjects (966 males and 992 females) were classified into 18 age groups from 0 to 5 years up to 85 years and above by 5-year intervals. Ear length, ear width, and length of ear attachment were measured with calipers. Human auricular cartilage was obtained from 26 subjects (16 males and 10 females) aged 14 to 79 years, stained by orcein, and examined by light and electron microscopy. RESULTS: Each item of measurement of human auricular size increased significantly with age in both males and females. On morphological examination by light and electron microscopy after orcein staining, elastic fibers in the cartilage were almost homogeneous in diameter and surrounded the cartilage lacuna in bundle-like fashion in young persons, whereas those in elderly persons were heterogeneous in thickness and had many fragments surrounding the territorial matrix. In elderly persons, collagen-like fibers and small vesicles with heterogeneous electron density were frequently observed near elastic bundles around the territorial matrix. CONCLUSION: Structural changes of auricular cartilage associated with morphological age changes of elastic fibers may be one of the causes of expansion of the auricle after reaching adulthood.     

A study on the prevalence of accessory auricle anomaly in Turkey

OBJECTIVE: Accessory auricular anomaly is a small elevation of skin containing a bar of elastic cartilage localized most commonly just anterior to the tragus or ascending crus of the helix. The anomaly may exist isolated or may be associated with other congenital anomalies of the first arch. The purpose in this study is to detect prevalence of accessory auricle in Turkey and find out whether it is associated with other craniofacial anomalies or hearing loss. METHODS: The study was performed on 850 children from the age of 7 to 9 during a screening program in primary schools. Complete otolaryngologic examination and acoustic reflectometry measurements were performed on all the children. Full physical examination, tympanometric and audiometric evaluation and EEG measurements were added to the cases with accessory auricle anomaly. RESULTS: Among 850 children examined, four had accessory auricle anomaly and prevalence of the anomaly was calculated as 0.47% (95% confidence interval (CI), 0.13-1.20%). Children were developmentally normal, and no other congenital craniofacial or systemic anomaly was detected in any of the cases. Further, tympanometric, audiometric evaluations and EEG tests were in normal limits. CONCLUSIONS: In this study, the prevalence rate of the condition was calculated as 0.47%. Although one study from China reported this prevalence as 0.22%, the difference between the reported prevalances was not statistically significant. Further, although external ear anomalies may present together with cranifacial anomalies and neurologic disorders like epilepsy, neuromotor retardation and EEG disorders, in our cases, mental and motor development was normal and epilepsy history or abnormal EEG patterns do not exist. On the other hand, no hearing loss was found to be associated with accessory auricles.     

Bilateral chondrodermatitis helicis: case presentation and literature review

Chondrodermatitis helicis is a benign, painful lesion of the auricle affecting the elderly population, particularly men. These lesions usually affect the helix of the ear, although the antihelix and, less commonly, the antitragus may be involved. The lesions are most frequently unilateral, although bilateral involvement has been reported. An unusual case of bilateral involvement of the antitragus is presented. The etiologic and pathologic manifestations are reviewed and current treatment modalities outlined.     

耳内镜鼓膜修补术后并发耳廓软骨膜炎2例并文献复习

目的 报道2例耳内镜鼓膜修补术后并发耳廓软骨膜炎患者的病历资料,为临床医师提供参考。方法 对2例耳内镜鼓膜修补术后并发耳廓软骨膜炎患者采用抗炎、对症等治疗,对脓肿形成者广泛切开引流,清理坏死软骨。结合文献复习阐述耳廓软骨膜炎的发病原因、临床特点及治疗方法。结果 患者1随访4个月后复查右耳廓上端稍有塌陷畸形,修补鼓膜愈合良好,患者自觉听力改善,声阻抗示A型,纯音测听示气骨导差基本消失;患者2随访2个月后见伤口局部无渗出,切口逐渐对位愈合。结论 由于耳内镜鼓膜修补技术的广泛开展,对于耳屏软骨的操作增加。临床医生需警惕术后耳廓化脓性软骨膜炎的发生。手术中严格消毒,术后做好切口观察护理。发生后应早诊断,早治疗,尽可能减少耳廓畸形的发生。     

An unusual auricular malformation accompanied by accessory tragus: macrotragus

Definition of malformations of the tragus is important for terminology and treatment. Most common entities are the skin tag, accessory tragus, preauricular sinus, and cyst, whereas macrotragus is an uncommon and unaddressed deformity that should be distinguished from these. In this report, three cases with diagnosis of the macrotragus are presented. The tragus was uniformly large and displaced anteriorly, and external auditory meatus was not obliterated in all cases. For correction, excision of the excess tragal cartilage and skin was performed. In all cases, bilaterally symmetric tragus was achieved. There were no complications in the early postoperative period and there was no enlargement after 6 months of observation. Macrotragus and accessory tragus are different entities that should be distinguished for accurate diagnosis. They have similar histopathological but distinct anatomical characteristics. Although both are treated by a simple excision, in the case of macrotragus, special effort should be taken to leave enough cartilage to restore normal tragal contours. Presented at the 5th Congress of the Balkan Association for Plastic, Reconstructive Aesthetic Surgery, Kuşadası, Turkey, May 22–26, 2007.