Sensibility of the ear after otoplasty

Changes in skin sensibility occur in various postoperative plastic surgeries, especially when they involve major skin and subcutaneous dissection. There were no studies so far that objectively compared changes of ear sensibility. This prospective study was conducted to compare ear sensibility before and after otoplasty. Patients with prominent ears (n = 15) underwent bilateral otoplasty. Ear tactile sensibility was tested preoperatively and 6 and 12 months after surgery by Pressure Specified Sensory Device, an apparatus that quantifies cutaneous pressure sensation (g/mm(2)). Comparison between preoperative and 6-months postoperative results indicated an increment on mean skin pressure thresholds; however, mean thresholds between pre- and 12 months postoperative period were similar. Vibratory and hot/cold sensibility did not present any difference during this period. This is the first comparative assessment of ear tactile sensibility using quantitative methods. After otoplasty, initially there was reduction in an ear tactile sensibility, followed by a return to levels similar to preoperative sensibility.     

Reconstruction of the ear after tumor excision

Tumors of the external ear are frequent. A variety of defects, created by surgical excision, can be repaired with basic techniques under outpatient local anesthesia. Most often, the redistribution of local and adjacent tissue allows satisfactory reconstruction.     

The state of tinnitus after inner ear surgery

A retrospective study of several procedures--for either treatment of vertigo or resection of acoustic neuromas--was performed to determine their effect on tinnitus. Subjective ratings of the state of tinnitus (resolution, improvement, maintenance, or deterioration) were obtained by questionnaire. Surgical procedures performed for correction of vertigo frequently alter tinnitus. In general, procedures that conserve hearing--namely, retrolabyrinthine vestibular neurectomy (RVN), middle fossa vestibular neurectomy (MFVN), and endolymphatic shunt procedures (ELS)--have a 50% to 65% chance of helping relieve tinnitus and up to a 22% chance of worsening tinnitus. When there is no serviceable hearing, cochleovestibular neurectomy (CVN) offers the best cure rate for tinnitus (76%) and the least chance of worsening tinnitus (3%). When hearing is minimal and the patient complains of tinnitus, a CVN--rather than a labyrinthectomy--should be recommended. However, when useful hearing is present, a CVN is not usually recommended for relief of tinnitus, since the actual cure rates are only 35%. When vertigo is not a complaint, there is currently no surgical procedure known that can be recommended for the treatment of tinnitus.     

Laser assisted fixation of ear prostheses after stapedectomy

Three different lasers (erbium:YAG, holmium:YAG, alexandrite) were used to drill a hole at the end of the long process of the incus in order to fix an ear prosthesis after stapedectomy or small fenestra stapedectomy. The energy was coupled into a 250-microns core diameter zirconium-fluoride fiber. The operations were carried out on human temporal bone models from cadavers. The fiber was guided to the incus under the stereoscopic surgical microscope. The tissue response was examined under the scanning electron microscope, and after decalcification, histologically. These studies suggest the feasibility of using the erbium:YAG laser to improve the anchorage of the prosthesis on the incus and to increase the stability in ossicular chain reconstruction.     

Reconstruction of the ear after skin and perichondrium loss

Because no two auricular defects are exactly the same, the choice of a suitable method for ear reconstruction is essential. Location and size of the defect influence the choice of technique needed for reconstruction. The method of reconstruction varies if there is skin loss, skin and perichondrium loss, or full-thickness loss. The skin surrounding the defect should be examined to determined if it is lacerated, burned, or scarred to decide whether or not it can be used in reconstruction. A plan of treatment should be decided and explained fully to the patient. A small area of skin loss can be closed by undermining of the edges and direct closure. If this cannot be performed because the defect is too large, the perichondrium is then examined to decide whether or not it is intact.     

Thermal changes in a rabbit ear model after sympathectomy

The long-term cutaneous thermal changes and the degree of sympathetic reinnervation of the vessels after a distal sympathectomy in an experimental model are reported. Under general anesthesia, a distal sympathectomy was performed at the proximal portion of the central artery of a rabbit ear. The contralateral ear served as a control. A dual-channel digital thermometer was used to record periodic cutaneous temperatures in identical positions on the distal third of the ears. Sympathetic reinnervation was assessed with catecholamine histofluorescence in the dead animals. A mean difference in temperature of 1.2 degrees C (P less than 0.01) was recorded 12 months after surgery. All of the sympathectomized ears maintained higher temperatures than their contralateral controls. Arterial sympathetic reinnervation 3 months after surgery was sparse and inconsistent. No increased reinnervation was noted at 12 months.     

The nerve response after autotransplantation of the rabbit ear

Neurohistologic investigations on 16 autotransplants of the rabbit ear ranging from 3 weeks to 18 months after replantation are described. This study investigated degeneration and regeneration of the adrenergic nerves of the vascular system and the afferent endings in hairy skin. Histochemical techniques, including hematoxylin-eosin staining by cholinesterase and glyoxylic acid fluorescence, and impregnation techniques with silver and osmium-zinc iodide were used. Central nerve reinnervation was started as early as 3 weeks after autotransplantation and usually was completed after 8 weeks. Spotty small areas of incomplete reinnervation could be found in the skin adnexa (hairs) even after 18 months. After transplantation the regeneration nerves were not attached to the vascular wall and were not incorporated in the Schwann cells of the distal parts of the transected and repaired vessels. The newly formed adrenergic nerve plexus was less dense than the normal one. Areas of patchy reinnervation and denervation were observed in peripheral vessels after 18 months. The defects in the restoration of the adrenergic vascular plexus similar to insufficient afferent reinnervation of skin and vessels may be responsible for the cold intolerance seen clinically and experimentally.     

Successful partial ear replantation after prolonged ischaemia time.

We present the case of a 34-year-old male patient who had successful replantation of upper pole of pinna 33 h after amputation. As no vein was anastomosed, systemic heparinisation and subcutaneous injection of heparin to the replanted ear were used to encourage outflow. Complications included arterial spasm and bleeding. Management of similar cases as planned urgent cases rather than emergency cases is discussed.     

Reconstruction of the ear after skin and cartilage loss

Small defects (less than 1.5 cm) of the helix or antihelix of the middle third of the ear can be converted to a wedge-shaped excision and primary repair performed. In some cases, small Burrow's triangles on either side of the wedge must be exised from the scapha or antihelix to allow for closure without distortion or cupping. In addition, the resection may go across the conchal rim and include the bowl to allow for rotation without deformity.     

Intramyocardial sewing needle extracted one year after insertion

The successful removal of a sewing needle from the heart of a 36-year-old female one year after penetration.