Question Mark Ear Deformity: A Combined Method for Correction

Question mark ear deformity or Cosman ear is a very uncommon congenital alteration. The deformity includes a cleft between the posterior helix and the lobule, an increase in anterior projection, an abnormal superior third that modifies the superior crura and the scaphoid fossa, partial or complete absence of the antihelix, transposition of the lobule and antihelix (severe cases), and postauricular tags. The authors present a case of moderate question mark ear deformity treated using Mustarde sutures and two cartilage grafts to correct the support and the contour defect. Adequate correction of the deformity and symmetry was achieved for both ears. The technique described in this report is suitable for minimal to moderate defects.     

Porous polyethylene for the reconstruction of severe Cosman cleft ear deformities

“Cosman ear,” “question mark ear,” or “auricular cleft between the fifth and six hillock” are synonyma for a congenital malformation between the helix and the lobule. While there is no definitive surgical method for correction of this deformity, there is agreement that only minor forms can be satisfyingly corrected with local skin flaps, whereas severe deformities need autologous cartilage or similar for reconstruction. The present publication describes a new method to correct a bilateral severe Cosman cleft ear deformity with a porous polyethylene framework and a postauricular fascia flap, leading to an appealing aesthetic result.     

Innovative technique for correction of the congenital lop ear.

Congenital lop ear is a deformity affecting the upper third of the ear. It is characterised by varying degrees of lidding of the helix, reduction in the fossa triangularis, scapha compression, reduction or absence of the superior crus of the antihelix and an associated reduction in vertical height of the external ear. Reported strategies for the surgical correction of this deformity include simple excision of the excess overhanging cartilage, radial cartilage incisions of the helix to reverse its memory, various cartilage grafts from the surrounding ear or rib to strut or fill the defect, and mastoid hitching stitches to reinforce the repair. We present a novel technique using a reversed conchal cartilage graft to strut the deformed antihelix. The memory of the reversed conchal cartilage is used to correct lidding of the superior helix and obviates the need for intrinsic cartilage modification or excision. We have found a good aesthetic and structural result in a patient with bilateral congenital lop ear with 12 months follow up.     

An alternative approach for correction of constricted ears of moderate severity.

Moderately severe constricted ears are characterised by lidding, moderate reduction of the vertical height of the upper ear (reduced scapha, absent superior crus) and prominence with absent antihelix. Techniques described for the correction of moderate constricted ear deformities included an attempt to expand the upper part of the ear by various cartilage transection and/or flap techniques. In the current paper, an alternative approach is presented and is based on the recreation of an antihelix (with Mustarde sutures) and excision of the lidding without performing cartilage expansion procedures. The technique was used in four patients with satisfactory results despite the persistence of the deficient scapha and triangular fossa. No recurrence of the cupping deformity was observed (follow up ranged from 6 months to 4 years with a mean of 2 years) and this was attributed to the use of a 'mastoid hitch' as an adjunctive technique to prevent recurrence.     

Surgical correction of cryptotia using Medpor.

Cryptotia is a congenital auricular anomaly found more commonly in Orientals than whites. The characteristics of cryptotia are the invagination of the upper part of the auricle under the temporal skin and the deformity of the auricular cartilage. The goals of the repair of cryptotia are to release the upper ear from the side of the head to restore the retroauricular groove, to correct the malposition, and to correct the cartilaginous deformity. To lengthen the skin between the superior portion of the auricle and the scalp, the authors used both the modified Z-plasty and the temporal advancement flap. We partially detached the abnormal insertion of the superior auricular muscle at the upper part of the helix to make it weak. After complete exposure of the posterior aspect of the upper auricular cartilage, the constricted intrinsic transverse and oblique muscles were cut, and everting horizontal mattress sutures were inserted on the antihelix to expand the constricted body and crus of the antihelix. Thereafter, an ultrathin Medpor sheet (0.85-mm thickness) was fixed with 6-0 nylon sutures to the posterior aspect of the corrected antihelical cartilage for lengthening and splinting the relatively shortened upper pole of the deformed cartilage. This operative method is thought to be useful in maintaining the lengthened auricular height and shape, and in preventing the relapse of ear cartilage deformities.     

对耳轮过度前突畸形的整复

对耳轮过度前突为对耳轮的角度过锐，致使耳轮的位置相应后移，表现为与招风耳完全相反的畸形。畸形虽不十分明显，但影响美观。自１９９２年４月开始应用患侧耳廓软骨和耳后皮瓣对５例患者８只外耳进行治疗得到满意效果。认为文中所述方法是矫正对耳轮过度前突畸形的良好方法。     

对耳轮过度前突畸形的整复

对耳轮过度前突为对耳轮的角度过锐,致使耳轮的位置相应后移,表现为与招风耳完全相反的畸形。畸形虽不十分明显,但影响美观。自1992年4月开始应用患侧耳廓软骨和耳后皮瓣对5例患者8只外耳进行治疗得到满意效果。认为文中所述方法是矫正对耳轮过度前突畸形的良好方法。     

去表皮矩形皮瓣埋置法联合Z字成形术修复纵形耳垂裂

目的：探讨去表皮矩形皮瓣埋置法联合Z字成形术在修复纵形耳垂裂方面的应用。方法：在耳垂裂隙两侧局部形成去表皮矩形皮瓣，把两去表皮矩形皮瓣分别埋置进耳垂裂的外侧部的前面及内侧部的后面皮下囊袋。耳垂裂边缘Z字成形。结果：本组8例患者，患侧耳垂均形态圆滑、自然，无明显的瘢痕和切迹；并且与健侧耳垂大小、形状基本相同。结论：利用去表皮矩形皮瓣埋置法联合Z字成形术修复纵形耳垂裂，手术操作简单，保留了耳垂的最大组织量，效果好，是一种值得推广使用的方法。     

Congenital ear deformity: reconstruction using composite graft

We present a congenital deformity of the right ear, characterized by absence of the central portion of the helix and antihelix. The deformity was reconstructed by advancing retroauricular skin and closing the resultant defect with a composite graft from the posterior aspect of the left ear. This technique was performed in a single stage and required no incisions on the anterior surface of either ear. Postoperative appearance of the right ear was satisfactory, and donor deformity was minimal.     

Correction of congenital cupping of the ear

Summary Congenital cup ear is characterized by an acute downward folding of the superior one third of the auricle in association with faulty development of the antihelix. A technique is presented which corrects the deformity without placing a scar on the anterior aspect of the ear. It consists of excising a segment of cartilage from the superior portion of the ear, rotating it 90°, reversing it, and placing it as a free cartilage graft.     

The visor ear flap: a new method for reconstruction of upper helical defects

Helical defects in the upper pole of the ear have been traditionally reconstructed by a variety of techniques. However, some of these techniques decrease the length of the ear while others produce a bulky helix. This paper describes a new technique in which a visor flap is raised from the medial aspect of the ear to form the soft tissue cover of the helical rim. A rotation flap is subsequently raised to cover the donor defect of the visor flap and a conchal cartilage graft taken from underneath the rotation flap is used to construct the helical cartilage. This method has the advantage of being a single-staged procedure, avoids reduction in the length of the ear and provides acceptable cosmetic result. The visor ear flap should be a valuable tool in the armamentarium of reconstructive procedures for upper helical defects.     

Aesthetic otoplasty: the key point

Summary Various techniques have been used to correct prominent ears. This deformity is caused by the lack of formation of the natural fold along the antihelix, a hypertrophied concha or a combination of both. The authors present a simplified method of auriculo-plasty. The key point of the operation described in this paper is an incision on the upper part of the tail to the lower end of the antitragus in order to break the strongest point where the helix, antihelix and antitragus join [9]; also, anterior scratching of the ear cartilage along the line of the future antihelix and superior crus, as suggested by Stenstrom [12]. Only a single Vicryl stitch is used to transfix the fold at the antihelix tail, bending the scapha over the conchal cartilage to make the lobule fall into place. The results are satisfactory, with a normal looking antihelical fold. The ears should also feel normal and should not appear to have been operated on.     

两皮瓣法矫治先天性纵向耳垂裂畸形

目的介绍一种两皮瓣法矫正先天性纵向耳垂裂畸形的方法及其应用效果。方法以耳垂背面组织为蒂，于纵向耳垂裂口的两侧面，分别设计皮瓣，其中内侧耳垂较小的皮瓣去表皮后，插入外侧耳垂皮瓣下缝合固定，外侧耳垂皮瓣完全覆盖内侧去表皮的组织瓣，耳垂裂畸形得到完全矫正。结果本组7例患者，切口均工期愈合，皮瓣全部成活。随访2个月～1．5年，耳垂裂得到完全矫正，外形满意；切口瘢痕不明显；双侧耳垂对称，患侧耳垂较对侧正常耳垂在大小、形态方面，无明显的差异。结论两皮瓣法矫正先天性纵向耳垂裂畸形。方法简单易行，术后效果较好。     

Otoplasty: Shaping the antihelix

In completing a satisfactory repair of the prominent ear, the shape of the antihelical fold is often the key to the aesthetic outcome. Correction involves not just creating a fold in the antihelix but also establishing a smooth sweep or antihelical curve anterior to posterior as well. The essential components described include accurate scoring of the antihelical fold followed by placement of mattress fixation sutures, with emphasis on obliquely placed sutures to control the final curve and shape of the antihelix. Sutures placed obliquely can solve the problem of persistent upper-pole prominence as in a telephone deformity, or overfolding which can stigmatize otoplasty.     

单侧唇裂继发畸形整复术的术式改良

目的 探讨改良术式修复单侧唇裂术后继发唇、鼻畸形的效果.方法 手术切几线与口鼻轮廓线相一致,片使鼻翼外侧脚整体旋转复位,重建鼻槛及鼻底,通过鼻腔的V-Y黏软骨瓣使鼻翼软骨上推,矫正鼻畸形.结果 自2000年以来,应用此方法对69例单侧唇裂继发唇、鼻畸形患者进行了修复,均取得较满意的效果,术后瘢痕线不明显.结论 轮廓线切口以及鼻翼软骨上推复位的方法符合唇、鼻的解剖特征,是一种较好的手术方法.     

The correction of lower eyelid retraction with ectropion due to gravity with auricular cartilage —suspension of lower eyelid with cartilage sling

Summary There are many surgical treatments for lower lid ectropion, but very few are effective for lower eyelid retraction with ectropion because of the influence of gravity on the flap transferred to the cheek. In two cases, we have successfully treated lower lid ectropion by suspending the lower lid with the ear cartilage taken from the antihelix. We believe that ear cartilage taken from the antihelix is a suitable material to suspend the lower eyelid for correction of lower eyelid retraction with ectropion due to gravity acting on the flap.     

One-stage reconstruction of an acquired major ear defect using an auricular cartilage sling and temporal fascial flap

To reconstruct a major middle third auricular defect, a two-stage operation is usual, using a skin flap with cartilage support. In this paper, a one-stage operation for an acquired ear defect using an auricular cartilage sling and temporal fascial flap with skin grafting is reported. The auricular cartilage graft was harvested along the antihelix and used for the reconstruction of the helical rim. This is a simple, easy, and safe method of one-stage reconstruction for an acquired ear defect in properly selected patients.     

The question mark ear (congenital auricular cleft): a familial case

We describe here 2 patients with question mark ears in one family. They had the peculiar auricular deformities bilaterally. Both patients had a cleft between the helix and earlobe respectively. The upper portion of the auricle showed marked prominence. The mother also showed notching between the helix and earlobe. The literature is reviewed and discussed.     

Aesthetic otoplasty: A new technique

Our technique for the correction of the protruding ear deformity has been successfully used in 275 patients. It gives a natural look of the auricle, symmetrical results, and a decreased number of secondary surgical procedures. This technique is based on a careful planning of the operation and measurement of the auricle, a large posterior skin excision proportional to the protrusion, breaking of the keystone of the auricular cartilage (horizontal cut of the cartilage between the antitragus and antihelix for 10–12 mm), superficial scratching of the periochondrium of the antihelix, and deep scratching of the cartilage laterally and medially to the antihelix. The dressing remains on for only 24 hours.Presented at the Seventh International Congress of Plastic and Reconstructive Surgery, Rio de Janeiro, Brazil, May 20–25, 1979     

Nasoalveolar molding for infants born with clefts of the lip, alveolus, and palate

The principle objective of presurgical nasoalveolar molding (NAM) is to reduce the severity of the initial cleft deformity. This enables the surgeon and the patient to enjoy the benefits associated with a repair of a cleft deformity that is of minimal severity. Retraction of the premaxilla, presurgical elongation of the columella, correction of the nasal cartilage deformity, alignment of the cleft alveolar segments, increase in the surface area of the nasal mucosal lining, up-righting of the columella, and achieving close approximation of the cleft lip segments at rest result from gentle application of forces through the NAM appliance. Preservation of these presurgical changes is achieved through the coordinated and modified surgical technique of the primary cleft repair.