Aesthetics in ear surgery: A comparative study of different post auricular incisions and their cosmetic relevance

Post auricular incisions play a very important role in the final post operative position of pinna and hence keeps a cosmetic bearing. This study shows that “behind the groove” incision gives a better post operative result in terms of minimal deviation of pinna and thus is cosmetically a better incision. This study also includes a new method to measure the conchomastoid or the post auricular angle. This paper was awarded the first prize in the Post Graduate award paper section at 58th AOICON (All India Conference of Otolaryngologists of India) held at Lucknow, 5th–8th Jan 2006     

Preservation of the great auricular nerve during parotidectomy

The great auricular nerve is routinely divided during the operation of parotidectomy, however some surgeons have suggested that preserving the posterior branches reduces the area of post-operative anaesthesia. A prospective study was performed comparing the area of anaesthesia and hypoaesthesia in patients undergoing parotidectomy. In 20 patients the great auricular nerve was preserved and in 11 it was sacrificed. Mapping of the area of sensory loss at 2 weeks, 3, 6, 9 and 12 months showed that there was no difference between the two groups. The area of sensory loss decreased in an exponential fashion in both groups. The majority of the change occurred within 6 months. We conclude that preservation of the posterior branches of the great auricular nerve is unnecessary.     

先天性小耳畸形头面部合并症的围手术期处理

先天性小耳畸形患者的全耳廓再造手术是整形外科具有挑战性的手术之一[1-3],且患者常伴中耳畸形,解剖结构复杂,面神经畸形的发生率很高[4],如果同期进行听力重建,则更增加手术的风险。因此,术前要对患者进行全面评估,把握好手术适应证,同时术前、术中、术后应该对可能影响手术疗效的因素进行处理。本文对先天性小耳畸形的围手术期影响因素及处理措施加以讨论。     

An evaluation of auricular prostheses using osseointegrated implants

The purpose of this evaluation is to compare whether retention of auricular prostheses, through utilization of osseointegrated implants rather than by adhesives, provides any improvement in patient acceptance and prosthesis longevity. Forty-seven out of a total of 49 patients having facial prostheses, retained by means of Brånemark fixtures, were surveyed. Ease of retention was noted in 91% of the patients. Satisfaction with the shape of the prosthesis, colour and ease of positioning was 100, 85 and 98% respectively. None of the patients experienced skin irritation under the prosthesis and 94% of them wore their prosthesis daily. Of the 13 patients with previous prosthesis experience, 92% stated improved retention and all of them found ease of positioning and wearing comfort had improved. Durability was better in 62%, unchanged in 23% and worse in 15% of these 13 patients.     

Histological analysis of the greater auricular nerve and its use as a graft

Many factors are involved in successful nerve grafting. Morphometric similarity between donor and recipient nerve is one of these factors. A histological study was undertaken to determine the suitability of the greater auricular nerve as a graft in head and neck surgery. Nerves were obtained from fresh human cadavers and evaluated for length, total cross-sectional area, total fascicular cross-sectional area and fascicular number, at three separate points along the nerve. Comparisons were made with similar studies of the sural and facial nerve. The study confirms the clinical view that the greater auricular nerve is ideal when short sections of graft are required in head and neck surgery.     

The histology of autologous auricular cartilage implanted into the nasal septum

This study attempts to evaluate the use of auricular cartilage for the treatment of nasal septal defects. A defect was made in the nasal septal cartilage in five rabbits and auricular cartilage grafted into the defect. The cartilage was microscopically examined 4 weeks later. The implanted cartilage was completely covered by ciliated columnar epithelium with minimal scar formation. Proliferation of the implanted cartilage and scattered ossification were observed. Seventeen patients with a nasal septal defect were treated by auricular cartilage implantation from April 1987 to through June 1992. Fiften patients (88%) had relief of symptoms and showed complete closure of the defect with a follow-up period of 2 years. The results of this study suggest that auricular cartilage may be of value in the repair of a nasal septal defect.     

耳甲腔成形术对乳突根治术疗效的影响

目的：探讨耳甲腔成形术对乳突根治术疗效的影响。方法：对１３３耳做耳甲腔成形术（成形组）及１８７耳未做耳甲腔成形术（对照组）的乳突极治术患者,进行疗效对比,结果：成形术后干耳时间平均为５．１周。术腔肉芽的发生率为６．４％,仅１例术后因残余胆脂瘤再次手术;对照组平均干耳时间为７．５周,术腔肉芽的发生率为２３．４％,有３例术后胆脂瘤复发,成形组无一例在冷空气环境中出现头晕,耳鸣,耳部不适等症状。结论：耳     

印迹法耳后皮瓣制备及修复耳郭前部皮肤缺损的临床效果

目的 评估印迹法制备耳后皮瓣及修复耳廓前部皮肤缺损的临床效果。 方法 2013年3月至2015 年9月对31例耳郭肿物患者术后较大的皮肤缺损采用耳后皮瓣修复。以纱布印迹法制备耳后皮瓣,皮瓣蒂部根据缺损的位置可在上部或下部。皮瓣蒂部皮肤去上皮后,经制备的软骨窗转位至耳郭前部皮肤缺损区。 结果 术后转移皮瓣全部成活。随访6~24个月,转移皮瓣皮肤颜色与耳郭及其周围皮肤颜色相似,未发生畸形改变。 结论 耳后皮瓣修复耳郭前部缺损手术操作简单,术后皮瓣成活率高,且供瓣区位于耳后,瘢痕隐蔽,能取得满意的美学效果,是一种修复耳郭组织缺损较好的方法。     

先天性耳廓畸形耳模矫正的疗效分析

目的 分析先天性耳廓畸形耳模矫正治疗的临床疗效。方法 回顾2019年1月—2021年12月在湖南省妇幼保健院耳鼻咽喉科门诊进行耳模矫正的201例（318耳）先天性耳廓畸形患儿,按患儿开始治疗的日龄将其分为3组：109例（181耳）<14 d的患儿为1组,75例（117耳）14～42 d的患儿为2组,17例（20耳）43～89 d的患儿为3组;分析3组患儿的治疗效果、治疗时长、并发症发生率等。结果 201例（318耳）先天性耳廓畸形患儿治疗的显效及治愈率为93.4%,佩戴时长平均（32.4±10.8） d,并发症发生率45.9%。3组的治疗显效及治愈率分别为96.7％、90.6％、80.0％,组间差异具有统计学意义（χ²=10.479,P=0.005）;3组的矫正时长分别为（30.2±10.4）、（35.2±10.8）、（35.5±9.7） d,组间差异具有统计学意义（F=8.940,P=0.000）;3组的并发症发生率分别为37.0％、59.8％和45.0％,差异具有统计学意义（χ²=14.900,P=0.001）。结论 先天性耳廓畸形患儿通过耳模矫正可获得良好的治疗效果,14 d内开始治疗有助于提高治疗效率,缩短治疗时长,降低并发症发生率。     

耳甲腔软骨在保留骨桥的鼓室乳突切除术中应用

目的　探讨并评价耳甲腔软骨在保留骨桥的鼓室乳突切除术（intact-bridge tympanomastoidectomy,IBM）中治疗慢性中耳乳突炎的临床效果。方法　本文总结分析2013年7月～2016年5月86例慢性化脓性中耳乳突炎,IBM采用耳甲腔软骨封闭上鼓室和鼓窦入口重建上鼓室,对术后效果进行评估。结果　所有病例随访不少于6个月,干耳时间4～6周。移植鼓膜一期愈合79例,重建上鼓室未塌陷。术后纯音测听气骨导间距≤20 dB者45.35%（39/86）,21～30 dB者39.53%（34/86）,≥31 dB者15.12%（13/86）;术后语频区平均气导听阈15～55 dB HL,平均（25.4±6.3）dB HL,语频区平均骨导听阈10～35 dB HL,平均（15.3±9.2）dB HL。结论　IBM采用耳甲腔软骨封闭上鼓室和鼓窦入口,重建相对完整的上鼓室,保证听骨链的活动空间,在根除病灶基础上保存或提高听力,是较佳的优化治疗选择。     

Combined reconstruction of congenital auricular atresia and severe microtia

OBJECTIVES: Due to their embryologic developments, auricular atresia and severe microtia are in most cases combined malformations. The aims of this study were to develop a surgical technique for combined esthetic and functional reconstruction with a minimum of operations and to evaluate the results. STUDY DESIGN: Prospective clinical evaluation. PATIENTS AND METHODS: Fifty-two patients with third-degree microtia and congenital aural atresia with a sound-conducting block of about 50 dB were treated as described here. In the first operation, autogenous cartilage is harvested and the auricular framework fabricated and implanted. In addition, the tympanic membrane and the external ear canal are prefabricated and stored in a subcutaneous pocket. In the second step, the elevation of the new framework is combined with the operation for atresia utilizing the prefabricated tympanic membrane and external ear canal. In the third step, the cavum conchae is deepened and the external ear canal opened and covered with a skin graft. RESULTS: Seventy-six percent of the patients had a final conducting hearing loss of 30 dB or less. No restenosis of the new external ear canal was observed. The esthetic results of the constructed auricles are shown. CONCLUSION: With this combination of plastic surgery for the auricle and functional surgery for the middle ear, no additional operations are necessary, and the prefabrication of the external ear canal and the tympanic membrane gives stable and reliable results. Therefore, we think that this combined technique offers the best chance for an optimal esthetic and functional rehabilitation of patients with these malformations.     

Therapy of auricular keloids: review of different treatment modalities and proposal for a therapeutic algorithm

Keloids are abnormal wound reactions of connective tissue. Auricular keloids can develop as a result of, e.g., otoplasty, ear piercing, or skin trauma. A wide variety of therapeutic options exists, including surgery as primary treatment. Furthermore, there are medical, physical, radiotherapeutic and experimental options. The present paper focuses on the different techniques including the therapeutic outcome and quality rating for each chosen pathway. In addition to the experience of the university hospitals, a thorough review of the literature was performed in order to update and compare today’s therapeutic options. Surgical techniques are customized to the lesion’s specific localization and extent. They may include revision of otoplasty. With medical treatment, established modalities such as steroid injection have to be distinguished from experimental methods like interferon, 5-FU, verapamil, imiquimod, or mitomycin C. Radiation is generally accepted to be effective, especially applied accompanying surgery, but needs to be restricted due to possible side effects. Physical therapy, e.g., pressure in a variety of application modalities, has gained a profound position in the therapy of auricular keloids. The success rates of the different treatment modalities vary markedly, and the number of patients per study is considerably low. Resuming the results, a periodic follow-up and good patients’ compliance are mandatory to early realize and treat auricular keloids. However, studies are needed to evaluate accepted and experimental therapies including larger number of patients.     

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。     

Role of posterior auricular muscle to prevent protruding ear after retroauricular ear surgery

ObjectiveThe posterior auricular muscle (PAM) functions in ear projection in normal position and is severed during the retroauricular approach, and some patients complain of a protruding ear postoperatively. This study was designed to determine whether suturing of the severed PAM reduces pinna projection after the retroauricular approach.MethodsIn a prospective controlled study, we enrolled 91 patients with chronic otitis media, all of who underwent canal wall up mastoidectomy with tympanoplasty via retroauricular approach. They were randomly assigned to the PAM-sutured (n = 45) or PAM-non-sutured (n = 46) group. Helical-mastoid distance and concho-mastoid angle were measured serially.ResultsIn both groups, helical-mastoid distance was significantly longer than preoperatively until 1 month postoperatively but was similar to preoperatively by 6 months. Concho-mastoid angle increased significantly until 1 month after surgery in the PAM-non-sutured group but returned to the preoperative value at 6 months postoperatively. In the PAM-sutured group, concho-mastoid angle increased significantly at 3 days postoperatively, was similar to preoperatively at 1 month after surgery, and became narrower than preoperatively at 6 months postoperatively. In both groups, there were significant effects of time on the changes in helical-mastoid distance or concho-mastoid angle. Group assignment did not significantly affect these time-related changes.ConclusionPAM suturing did not affect helical-mastoid distance by 6 months postoperatively, but it did reduce the concho-mastoid angle to below the preoperative value at 6 months. We recommend that PAM be left severed to maintain concho-mastoid angle in the long term when using the retroauricular approach.     

耳大神经阻滞对人工耳蜗植入术后患儿苏醒期谵妄的影响

目的 评价耳大神经阻滞对七氟烷全麻人工耳蜗植入术患儿苏醒期谵妄(ED)的影响。 方法 择期七氟烷全麻下单侧人工耳蜗植入术患儿80例,0~6岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表法分为耳大神经阻滞组(A组)和对照组(B组)。麻醉诱导后,A组在超声引导下耳大神经周围注入0.2%罗哌卡因1 mL,B组在切口周围注射2%利多卡因2 mL。七氟烷维持麻醉。术后使用儿童麻醉苏醒期谵妄量表(PAED)评估ED发生率,使用面部、腿部、活动、哭泣和安慰程度量表(FLACC)评估术后疼痛。PAED≥13分或FLACC≥4分者,给予芬太尼0.5 μg/kg静脉注射。记录患儿七氟烷平均用药浓度、ED持续时间、拔管时间、麻醉后恢复室(PACU)停留时间、芬太尼总用药量、护士满意度评分和术后24 h内不良反应发生率。 结果 与B组比较,A组ED发生率(P=0.036)和PAED(P=0.024)评分降低,FLACC评分(P=0.008)和FLACC≥4分的比率(P=0.006)降低,芬太尼补救镇痛率(P=0.011)降低,PACU停留时间(P=0.040)缩短,护士满意度(P=0.021)得到改善(P均<0.05),PAED≥13分的比率(P=0.289)、ED持续时间(P=0.962)、拔管时间(P=0.913)和术后不良反应发生率(P呕吐=0.737;P呛咳=0.487;P低氧=1.000)差异无统计学意义(P均>0.05)。 结论 耳大神经阻滞能降低七氟烷全麻人工耳蜗植入术后儿童苏醒期谵妄的发生率、减轻术后疼痛且不增加术后不良反应发生率。     

Microanatomic analyses of extratemporal facial nerve and its branches,hypoglossal nerve,sural nerve,and great auricular nerve

ObjectiveTo investigate microanatomic organizations of the extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve.MethodsNerve samples were dissected in 12 postmortem autopsies, and histomorphometric analyses were conducted.ResultsThere was no significant difference between the right and left sides of the nerve samples for the nerve area, fascicle area, number of fascicles and average number of axons. The lowest mean fascicle number was found in the hypoglossal nerve (4.9 ± 1.4) while the highest was in great auricular nerve (11.4 ± 6.8). The highest nerve area (3,182,788 ± 838,430 μm²), fascicle area (1,573,181 ± 457,331 μm²) and axon number (14,772 ± 4402) were in hypoglossal nerve (p < 0.05). The number of axons per unit nerve area was higher in the facial nerve, truncus temporofacialis, truncus cervicofacialis and hypoglossal nerve, which are motor nerves, compared to the sural nerve and great auricular nerve, which are sensory nerves (p < 0.05). The number of axons per unit fascicle area was also higher in motor nerves than in sensory nerves (p < 0.05).ConclusionIn the present study, it was observed that each nerve contained a different number of fascicles and these fascicles were different both in size and in the number of axons they contained. All these variables could be the reason why the desired outcomes cannot always be achieved in nerve reconstruction.