Otoplasty: an analysis of technique over a 33-year period

OBJECTIVE: To compare the merits of otoplasty technique with a diverse patient population as experienced spanning a period greater 30 years. STUDY DESIGN: A review of a series of otoplasty cases that occurred in two distinctly different clinical settings during a 33-year period. METHODS: A retrospective analysis of 211 patients undergoing otoplasty from 1969 to 1982 in a military hospital setting was compared with 118 patients receiving otoplasty from 1982 to 2002 in a university/private practice setting. The patient population consisted of 180 adults and 149 children. RESULTS: Otoplasty patients in the military setting were primarily adults, whereas those in the university/private practice setting were primarily children. In the adult population, 98.9% of patients required use of lateral conchal cartilage resection combined with a mattress suture technique. In the pediatric population, all patients required use of a mattress suture technique and in 83.2% of selected cases limited lateral conchal cartilage resection was required. CONCLUSION: Otoplasty technique involving lateral conchal cartilage resection, mattress suture fixation, or a combination of both is applicable to diverse patient populations.     

Otoplasty technique

Otoplasty remains a challenging but rewarding operation for surgeons who approach it in a rigorous and exacting manner. This article outlines a particular systematic approach to cartilage-sparing otoplasty and related adjuvant procedures. Whichever methods are chosen, precise adherence to the goals and principles summarized herein will help ensure optimal surgical outcomes and associated patient satisfaction.     

Rhinomanometry: an update

Rhinomanometry has been widely accepted and used as an objective method to assess nasal patency for more than two decades. Much knowledge was obtained with its application in nasal pathophysiology and measuring techniques are still an issue for continuous improvement. Background, concept and current techniques, past, present and future, reliability, indications and contraindications are discussed in details. Special attention is paid to problems of definition, correlation between rhinomanometric data and subjective sensation of nasal patency and calibration. It is concluded that rhinomanometry applied together with acoustic rhinometry gives the most reliable objective information on nasal patency in an authentic rhinologic laboratory.     

Otoplasty: critical review of clinical results

Although it is generally believed that otoplasty provides uniformly gratifying results, thorough patient follow-up reviews are quite rare. Otoplasty surgery performed on 119 ears was retrospectively reviewed to assess the results of our cartilage-sparing technique. This method of otoplasty relies on a conchal set-back and suture transfixation technique to improve the antihelical contour. Auricular medialization averaged 10.3 mm. Over-correction is required, particularly in the superior pole, as loss of correction with healing was approximately 40% of the initial medialization. Revision surgery due to loss of correction was necessary for 6.6% of the ears initially operated on by the senior author. Patients who presented following cartilage-cutting procedures tended to have a higher rate of revision and persistent postoperative stigmata. Complications in general were few; however, mersilene suture extrusion occurred in 8% of ears. Only one of these required revision surgery for associated loss of correction. Despite these drawbacks, over 95% of patients achieved satisfactory results using cartilage-sparing otoplasty techniques.     

Microtia reconstruction: an update

Reconstruction of the microtic ear remains one of the most challenging procedures encountered by the reconstructive surgeon. The use of autogenous rib cartilage continues to be the gold standard for microtia repair. Numerous refinements and modifications in the original technique described by Tanzer have paved the way for exceptional results in experienced hands. However, ideal results are not always achieved, and there continue to be drawbacks with the standard approach to reconstruction with autogenous rib cartilage. In an attempt to circumvent these shortcomings, surgeons have developed alternative or adjuvant techniques to repair the microtic ear, including the use of tissue expansion, alloplastic implants, and osseointegrated prostheses. Finally, greater emphasis is being placed on early atresia repair in appropriate candidates.     

Auricular reconstruction: an update

PURPOSE OF REVIEW: One of the greatest challenges in facial plastic surgery is total auricular reconstruction. The ability to construct a fully satisfactory complete external ear has for centuries been an elusive goal. With advancing standards and expectations in plastic surgery, greater focus is being directed to this arena of reconstruction as well. RECENT FINDINGS: With advances both in surgical technique and biotechnology, an expanding range of options is available to the reconstructive surgeon who is willing to take on this still formidable task. While progress continues to be made in the detailing of costal cartilage grafts and soft-tissue rearrangement, it is also being made with the use of alloplastic implants and prostheses. The most promising field of advances, with the hope of eventual clinical utility, lies in the realm of bioengineering with cultured cartilage. SUMMARY: Review of the literature over the past year reveals several reports describing advances made in the development of cultured chondrocytes with attempts to direct special shape to the manufactured neocartilage. Though advances continue to be made, actual clinical applicability of this technology is still insufficient while expectation continues that this will eventually become integral to total auricular reconstruction.     

Otoplasty: results of suturing and scoring techniques

In this study, we evaluated our otoplasty surgery results in patients with prominent ears. A total of 76 ears in 42 patients (20 male, 22 female; mean age 14; range 6–34 years) who underwent otoplasty surgery under general anesthesia between April 2005 and February 2012 were evaluated retrospectively. Of the 76 surgical cases, while 65 were operated on for the first time (primary), 6 had had previous unsuccessful surgical interventions at other institutes (secondary) and 5 were our own revision surgery cases. Of the primary cases; 11 had unilateral and 27 had bilateral surgery. Postoperative follow-ups were performed at week one, months one, three and six and at 1 year. While 60 of the 65 primary surgeries and all 6 of the secondary surgeries had successful results, 5 cases required revision surgery. The revision otoplasty surgeries were found to be successful in all patients on follow-up visits. Otoplasty surgery is an effective treatment method with high success rates for patients with prominent ears.     

Otoplasty: results after anterior versus posterior approach

Introduction and objectiveIn otoplasty, an anterior approach with sutures is commonly used, because it is not aggressive with cartilage. The aim of this study on otoplasty was to evaluate the usefulness of the anterior approach, comparing it to the results obtained after the posterior approach.Material and methodsRetrospective study on 25 otoplasties performed at a University Hospital during the period 2004-2008. Clinical records from 13 patients (25 otoplasties), between 7-41 years of age, were reviewed. In the anterior approach, the anterior surface of the auricular cartilage is scratched with a rasp. The antihelix shape is obtained and mattress sutures are placed through the anterior surface of the ear.ResultsOut of 25 otoplasties, 92% were bilateral and 8%, unilateral; 54% of the patients were children and 46%, adults; anaesthesia was local in 20% and general in 80%. We performed 11 anterior and 14 posterior approach otoplasties. After an anterior approach, complications were suture extrusion in 82%, foreign body reaction in 9%, and revision surgery was needed in 28% of 11 otoplasties performed. After a posterior approach, complications were suture extrusion in 21%, foreign body reaction in 7%, and revision surgery was needed in 7% of 14 otoplasties performed. A good aesthetic result was obtained in almost all the cases (85%). Extrusion rate was statistically more common after the anterior approach.ConclusionsIn our opinion, otoplasty is a simple technique for treatment of prominent ears, with good aesthetic results. The most common complication is suture extrusion, more frequent after an anterior approach.     

Otoplasty: a review of the surgical techniques

? Otoplasty surgery carries a high satisfaction rate for participants (96%). ? Surgeons are more critical of the results of otoplasty than the participants or parents (92% satisfied). ? There is no statistical difference in qualitative results with different surgical techniques when comparing the published data. ? Data on otoplasty surgery is numerous, but quantitative assessment of surgical outcome is rare. ? The authors propose the measurement of cephaloauricular distance to allow comparison between studies.     

Sudden hearing loss: an update

Etiologic theories of idiopathic SHL include viral infection, autoimmune disease, vascular insult, and labyrinthine membrane rupture. A review of recent literature on sudden hearing loss indicates that scientific support for viral and autoimmune etiologic mechanisms is increasing. Recently studied treatment protocols include carbogen inhalation and steroid therapy. In patients with moderate hearing losses, oral steroids may be beneficial.     

Sinonasal undifferentiated carcinoma: an update

PURPOSE OF REVIEW: Sinonasal undifferentiated carcinoma is a rare and extremely malignant tumor of the paranasal sinuses. Historically, treatment outcomes have been poor. This review presents recent data on the management of sinonasal undifferentiated carcinoma and examines treatment trends that may result in improved locoregional control and survival. RECENT FINDINGS: Patients who receive aggressive multimodality treatments have improved outcomes. In particular, a chemoradiotherapy regimen including concurrent platinum-based chemotherapy given preoperatively or postoperatively to patients with resectable disease seems to result in better disease-free survival. Neoadjuvant chemotherapy, although strongly advocated by some, is currently not offered by many. Although surgery seems to be an important part of the treatment for sinonasal undifferentiated carcinoma, its ideal timing, either upfront or after radiotherapy, remains uncertain. SUMMARY: Overall, outcomes for sinonasal undifferentiated carcinoma are poor. An aggressive approach using surgery, platinum-based chemotherapy, and radiation seems to offer the greatest chance for significant locoregional control and survival.     

Endonasal laser surgery: an update

Although surgical lasers were introduced more than 30 years ago,their use and popularity in nasal and sinus disease have been limited. Even so, there are many practitioners who find the laser a valuable surgical tool for nasal and sinus disease, either alone or in combination with other treatment modalities. Those who do not use lasers probably do not because of a lack of skill, knowledge,or understanding of the role and availability of the technology. This article reviews the history and current role of lasers in nasal and sinus surgery.