Posterior Auricular Muscle Flap as an Adjunct To Otoplasty

Prominent ear deformity is a common congenital ear deformity. Prominent ear deformity includes components such as valgus of concha, failure of scaphal folding, conchal hypertrophy, and prominent lobule. The deformity and the elastic properties of the ear cartilage determine the method of surgical correction in each case. Concha-mastoid suture, conchal excision, and posterior auricular muscle excision are different treatment options for mild to severe cases of conchal hypertrophy and valgus deformity. In this article we present a method of conchal excision, combined with a posterior auricular muscle flap, to repair severe conchal hypertrophy or valgus deformity. Six patients (11 ears) were operated on using this method. The results obtained were satisfactory. Postoperative results at 6 months were satisfactory in all patients. The smoothness and the natural appearance of the conchal bowls were notable in all patients. In contrast to the early methods of utilizing the posterior auricular muscle by transposing to the scapha or excising, its usage as a muscle flap for conchal hypertrophy and valgus deformity may be a promising option for the future.     

Chongchet's otoplasty: not only a method of anthelix reconstruction

The cause of prominent ear deformity may be anthelix deficiency or a high conchal wall [2]. Chongchet's otoplasty [3] is an old method described for correction of anthelix deficiency via anterior scoring. The aim of this study is to show the use of Chongchet's otoplasty in conchal wall reduction and the use of auricular cartilage tension lines in surgical correction of prominent ear deformity. In 24 prominent ear cases with different causes anterior scoring was performed along the auricular cartilage tension lines. Conchal reduction as well as antihelical reconstruction was easily achieved by folding the cartilage; excess conchal wall cartilage was excised laterally. Long-term results show pleasing contours without any recurrence. In conclusion, Chongchet's otoplasty which permits conchal wall reduction and anterior scoring according to auricular cartilage tension lines facilitates conchal and antihelical folding.     

Staged, laminated, costal cartilage framework for ear reconstruction

Two features of greatest importance in achieving a normal appearance in the reconstruction of an ear with microtia are that a conchal component with sufficient size, shape, and depth is present; and that auricular projection, sufficient in degree to show contours that appear normal from a posterior view, is present. The authors describe the construction of a staged, laminated framework that helps achieve these goals.     

Reduction of Conchal Enlargement and/or Anterolateral Rotation: Otoplasty by the Cosmetic Dermatologic Surgeon

BACKGROUND: Otoplasty is the correction of protuberant ears. One of the most common malformations responsible for prominauris is conchal enlargement and/or anterolateral rotation. The surgical technique we utilize for the correction of this type of auricular malformation is not unlike the removal of auricular skin and cartilage frequently performed by dermatologic surgeons in the treatment of cutaneous malignancies of the ear. OBJECTIVE: To introduce the reduction of conchal enlargement and/or anterolateral rotation for the correction of protuberant ears into the armamentarium of the cosmetic dermatologic surgeon. METHODS: We describe in detail the development and anatomy of the ear along with indications, preoperative considerations, surgical technique, postoperative care, and potential complications for this type of cosmetic surgery. RESULTS: The technique described herein is an effective approach in the surgical management of protuberant ears that are caused by conchal enlargement and/or anterolateral rotation. CONCLUSION: With proper patient selection, thorough knowledge of this step-by-step surgical approach to otoplasty, and some prior surgical experience involving the skin and cartilage of the external ear, the successful correction of protuberant ears is well within the scope of the cosmetic dermatologic surgeon's practice.     

Reconstruction of the anterior surface of the ear using a postauricular pull-through neurovascular island flap

The auricular conchal cavity is a shallow structure in the central part of the ear. It is not only 3-dimensional, but it is a gateway to the external ear canal. Many methods have been described for reconstruction of the defect of concha-antihelix: split- or full-thickness skin grafts, regional skin, chondrocutaneous and musculocutaneous flaps, but none of the authors have described this flap with neurovascular pedicle. We used postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches to the skin color, thickness and texture; scars are well hidden, and there is no donor-site morbidity. Moreover, it has a constant and reliable neurovascular pedicle. The flap edema which was present in the early postoperative period began to resolve gradually after 3 weeks and disappeared in a few months. The esthetic results were excellent in all of the patients and very satisfying for the patients, too. The sensibility was positive by light touch, pin-prick, temperature and static 2-point discrimination in the postoperative control. The static 2-point discriminations in the transferred flap and in the other ear, which corresponds to the same area, were measured. The results were nearly the same as normal values. We advocate postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches the skin color, thickness and texture; scars are well hidden, and there is no donor site morbidity. Moreover, it has a constant and reliable neurovascular pedicle.     

The Incidences of Chondritis and Perichondritis Associated With the Surgical Manipulation of Auricular Cartilage

BACKGROUND: The cartilage and soft tissues of the ear are frequently employed as donor sites for tissue used in the repair of defects of the nose and external ear after Mohs surgery. Enthusiasm for using these auricular donor sites is occasionally tempered by surgeons' concerns for the development of Pseudomonal suppurative chondritis, a complication that has been described to follow cartilage manipulation. OBJECTIVE: To quantify the incidence of postoperative perichondritis and chondritis after Mohs reconstructions involving auricular cartilage manipulations. METHODS: We retrospectively reviewed 341 Mohs reconstructions that involved cartilage and soft-tissue donor sites located on the ear. Procedures included full-thickness skin grafts (295) harvested from the conchal bowl and flap repairs (46) incorporating cartilage batten grafts from conchal or anthelix donor sites. When the perichondrium was compromised, patients were routinely prescribed perioperative prophylactic antibiotics with Pseudomonal coverage. Postoperative examinations were performed at 1 week and 4 to 12 weeks. Patients not seen in clinic were interviewed by telephone regarding complications. RESULTS: Complete follow-up information was obtained in 337 of 341 (98.8%) cases. Inflammatory perichondritis was observed in 19 (5.6%) patients. There were no cases of suppurative chondritis. CONCLUSION: The incidence of inflammatory perichondritis is low after Mohs reconstructions involving auricular cartilage manipulation. When prophylactic antibiotics and appropriate operative technique are used, the historic concern for suppurative chondritis associated with these procedures is unwarranted.     

Technique of total ear reconstruction with open framework, composite pseudomeatus graft, and postauricular transposition flap

Modifications of Tanzer's technique of total reconstruction of the auricle are described, emphasizing the construction of a deep conchal cavity and pseudomeatus, with ample projection of the auricle. To obtain a more prominent projection of the auricle, a transposition flap from retroinfra-auricular skin is used, with placement of small cartilage props beneath the framework. The depth of the conchal cavity is enhanced by excavation of soft tissues and placement of an additional cartilage graft at the posterior wall of the choncha. The external meatus is imitated by a cone-shaped composite graft taken from the cymba of the opposite ear.     

The contoured auricular projection graft for nasal tip projection

In all rhinoplasty surgery, the universal need exists to increase, decrease, or preserve existing tip projection. When proper tip projection is lacking, a variety of techniques are useful for improving projection. We describe a valuable technique for tip projection, particularly useful and indicated in the Asian rhinoplasty, African American rhinoplasty, and in certain revision rhinoplasties. In the past 15 years, the senior author (M.E.T.) has used the contoured auricular projection graft in selected patients for achieving satisfactory tip projection in patients with blunted tips. The aesthetic outcomes have been predictable, pleasing, and reliable for the long term. Precision pocket preparation for auricular conchal cartilage graft placement is key to symmetry and projection of the final outcome. The results yielded a rounded nasal tip that may be more natural-appearing in Asians, African Americans, and selected patients with revision rhinoplasty. The contoured auricular projection graft provides a highly useful graft for the nasal tip.     

Age- and sex-specific association of circulating osteocalcin with dynamic measures of glucose homeostasis

Summary

Our study showed that serum osteocalcin levels are closely related to glucose metabolism in men of all ages and younger women. This association disappeared in postmenopausal women in which increases bone turnover rates. The association between serum osteocalcin levels and glucose homeostasis should be interpreted according to age and sex.

Introduction

Osteocalcin, a marker of bone formation, appears to be associated with glucose homeostasis. We investigated the age- and sex-specific association of serum osteocalcin level with variables related to glucose metabolism.

Methods

This study was based on cross-sectional analysis from 719 participants aged 20–85 years after excluding patients taking antidiabetic or antiosteoporotic drugs. The subjects were divided into four groups according to age and sex as follows: men <50 years (n?=?131), men ≥50 years (n?=?191), women <50 years (n?=?108), and women ≥50 years (n?=?279). Anthropometric and biochemical variables including insulin resistance (HOMA-IR) and β cell function (HOMA-β) from a 75-g oral glucose tolerance test, and serum 25-OH-vitamin D and parathyroid hormone levels were measured.

Results

The serum osteocalcin level was significantly higher in women aged ≥50 years compared with women <50 years (20.4?±?7.8 vs. 17.9?±?6.8 ng/ml, p?<?0.001), but there was no difference between men aged ≥50 years and men <50 years (16.4?±?5.9 vs. 16.8?±?6.0 ng/ml, p?=?0.905). The participants diagnosed with diabetes had lower serum osteocalcin levels than normal or prediabetic participants. Multivariable regression analyses including HOMA-IR and HOMA-β indicated that serum osteocalcin levels had a negative and independent association with HbA1c levels in men and women aged <50 years, but not in women ≥50 years.

Conclusions

Low osteocalcin levels are associated with impaired glucose metabolism in men and premenopausal women. The osteocalcin levels may be determined by factors related to bone metabolism in postmenopausal women. Our data suggest that the serum levels of osteocalcin associated with glucose homeostasis should be interpreted according to age and sex.

     

健康年轻女性耳垂测定及相关因素分析

目的:探讨健康年轻女性不同身高、体重对耳垂形态的影响,为耳垂整形手术提供参考资料。方法:2016年3—7月,郑州大学第一附属医院整形外科测量266名健康年轻女性的身高、体重、耳宽形态、耳长形态、耳宽貌、耳长貌、耳垂宽、耳垂长等项目,计算各测量值 ± s,对有关各项指标用SPSS 15.0统计软件...     

Prevalence of sarcopenia and associated factors among Thai population

The purpose of this study was to determine the prevalence of sarcopenia using the skeletal muscle index (SMI) criteria in the Thai population. The secondary objective was to demonstrate factors influencing low SMI in this population. Femoral neck bone mass density (BMD) was measured by dual-energy X-ray absorptiometry (GE Lunar, Madison, WI, USA) in 435 urban and 397 rural subjects (334 men and 498 women) between 20 and 84 years of age. Body mass index (BMI) was calculated from weight and height. The respective prevalence of sarcopenia among men and women was 35.33 % (95 % CI, 29.91, 40.41) and 34.74 % (95 % CI, 30.56, 39.10). Factors associated with sarcopenia using multiple logistic regression analyses in both sexes were (a) living in the city, (b) higher BMI, and (c) older age. Living in an urban area was the strongest factor, with an odds ratio (OR) of 17.26 ± 7.12 (95 % CI, 7.68, 38.76) in men and 8.62 ± 2.74 (95 % CI, 4.62, 16.05) in women (p < 0.05). The prevalence rate ratio for persons living in urban compared to rural areas was 2.01 (95 % CI, 1.14, 3.53) in men and 1.69 (95 % CI, 1.31, 2.17) in women (p < 0.05). Sarcopenia, as based on SMI, occurs frequently in the Thai population and increases with age. The prevalence of sarcopenia is particularly high among pre-retirement women (50–59 years of age) whereas the number of men with sarcopenia gradually rises with age. An urban environment is the most predictive factor for sarcopenia, followed by high BMI and age. Given the aging population, early recognition of this condition can be beneficial for prevention of an epidemic of sarcopenia-related disability.     

Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study

Concerns about bone health in transgender people using gender-affirming hormonal treatment (HT) exist, but the fracture risk is not known. In this nationwide cohort study, we aimed to compare the fracture incidence in transgender people using long-term HT with an age-matched reference population. All adult transgender people who started HT before 2016 at our gender-identity clinic were included and were linked to a random population-based sample of 5 age-matched reference men and 5 age-matched reference women per person. Fracture incidence was determined using diagnoses from visits to hospital emergency rooms nationwide between 2013 and 2015. A total of 1089 trans women aged <50 years (mean 38 ± 9 years) and 934 trans women aged ≥50 years (mean 60 ± 8 years) using HT for median 8 (interquartile range [IQR] 3–16) and 19 (IQR 11–29) years, respectively, were included. A total of 2.4% of the trans women aged <50 years had a fracture, whereas 3.0% of the age-matched reference men (odds ratio [OR] = 0.78, 95% confidence interval [CI] 0.51–1.19) and 1.6% of the age-matched reference women (OR = 1.49, 95% CI 0.96–2.32) experienced a fracture. In trans women aged ≥50 years, 4.4% experienced a fracture compared with 2.4% of the age-matched reference men (OR = 1.90, 95% CI 1.32–2.74) and 4.2% of the age-matched reference women (OR = 1.05, 95% CI 0.75–1.49). A total of 1036 trans men (40 ± 14 years) using HT for median 9 (IQR 2–22) years were included. Fractures occurred in 1.7% of the trans men, 3.0% of the age-matched reference men (OR = 0.57, 95% CI 0.35–0.94), and 2.2% of the age-matched reference women (OR = 0.79, 95% CI 0.48–1.30). In conclusion, fracture risk was higher in older trans women compared with age-matched reference men. In young trans women, fracture risk tended to be increased compared with age-matched reference women. Fracture risk was not increased in young trans men. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.     

Bone mineral density in the normal Iranian population: a comparison with American reference data

Summary In order to establish the normative curves for BMD in Iranian individuals, we measured BMDs at the lumbar spine and femoral regions of 760 women and 632 men using dual-energy X-ray absorptiometry. This study provides a baseline normative for Iranian individuals. BMD values of Iranian subjects were generally lower than those of the American population. Introduction In order to establish the normative curves for BMD in Iranian individuals, we measured BMDs at the lumbar spine and femoral regions. The BMDs at the lumbar spine and femoral neck regions of 760 women and 632 men, which were selected by multi-stage random sampling, were measured using dual-energy X-ray absorptiometry (DXA). Results The peak bone mass in the males and females at the lumbar spine was reached around the age of 28.5±1.5 and 30±2 and at the neck of the femur was reached around the age of 24±1.5 and 33±2. About 16.4% and 3% of men aged 50 and older were osteoporotic according to American reference data, respectively, but using Iranian normative data for L2-L4 and the neck of the femur, the corresponding values were only 13.4% and 2.1%. Using American reference data, the respective values in women aged 50 and older for the same regions were 44.4% and 12%, whereas according to the Iranian normative data, the corresponding rates were 41.1% and 10.4%. Conclusions This study provides a baseline normative for Iranian individuals. Due to the differences in ethnicity, diet, lifestyle, and small body size, BMD values of Iranian subjects were generally lower than those of the American population.     

Projected numbers of knee and hip arthroplasties up to the year 2030 in Japan

BackgroundThe aging population is a risk factor for an increase in osteoarthritis, leading to a potential increase in the number of arthroplasties worldwide. This study aimed to calculate the projected numbers of knee and hip arthroplasties in Japan until 2030 using national health insurance claim data.MethodsData on the numbers of knee and hip arthroplasties performed in Japan between 2014 and 2018 were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Open Data Japan. Demographic data were obtained from the National Institute of Population and Social Security Research. Collected data were categorized into three age subgroups (40–64, 65–74, and ≥75 years) for each sex. Projections were based on the Poisson regression model.ResultsThe number of knee arthroplasties in Japan in 2030 was projected to be 4052 for men aged 40–64 years, 6942 for men aged 65–74 years, 14,986 for men aged ≥75 years, 7092 for women aged 40–64 years, 22,957 for women aged 65–74 years, and 58,340 for women aged ≥75 years. The number of hip arthroplasties in Japan in 2030 was predicted to be 8936 for men aged 40–64 years, 9005 for men aged 65–74 years, 5972 for men aged ≥75 years, 27,327 for women aged 40–64 years, 36,416 for women aged 65–74 years, and 37,011 for women aged ≥75 years.ConclusionThe numbers of knee and hip arthroplasties are expected to continue to increase over the next 10 years in Japan in most age groups. These findings are useful for future healthcare resource planning to meet the demand for knee and hip arthroplasties.     

Morphometry of the External Ear in Our Adult Population

This study aimed to determine the mean values of the different morphometric measurements from right and left ears. These measurements were taken from 341 healthy young adults (150 women and 191 men) ages 18 to 25 years using an electronic digital caliper. The results showed the mean values for total ear height, lobular height and width, distances from tragus to antihelix and to helix, and ear projection and width to be, respectively, 59.7 ± 3 mm, 17.5 ± 1.4 mm, 18.5 ± 2.2 mm, 16.6 ± 1.7 mm, 25.1 ± 2 mm, 16.6 ± 2 mm, and 31.3 ± 2.2 mm for the left ear, and 59.5 ± 3.1 mm, 17.9 ± 1.5 mm, 18.9 ± 2 mm, 16.5 ± 1.8 mm, 25.2 ± 1.9 mm, 17 ± 1.9 mm, and 31.2 ± 2.2 mm for the right ear in the young women. However, in the young men, these values were, respectively, 63.1 ± 3.6 mm, 18.3 ± 1.7 mm, 19.4 ± 2 mm, 17.2 ± 1.8 mm, 26.3 ± 1.9 mm, 17 ± 2.3 mm, and 33.3 ± 2.2 mm for the left ear, and 62.9 ± 3.5 mm, 18.4 ± 1.7 mm, 19.8 ± 1.9 mm, 17.2 ± 1.8 mm, 26.6 ± 1.9 mm, 17.6 ± 2.1 mm, and 33.1 ± 2.1 mm for the right ear.     

Urinary incontinence and hydration: A population‐based analysis

Aims

To determine if there is an association between urinary incontinence (UI) and an objective measure of hydration status in men and women in a nationwide, population‐based sample.

Methods

We utilized data from the 2009 to 2010 and 2011 to 2012 National Health and Nutrition Examination Surveys (NHANES), cross sectional surveys of the US non‐institutionalized population. Our primary outcome was moderate/severe UI measured using a validated scale. Our exposure of interest was hydration status. Urine osmolality ≥ 800 mOsm/kg defined dehydration versus adequate hydration (<800 mOsm/kg). We included men and women ≥ 20 years who had both UI and urine osmolality data. Using multivariable models, we controlled for age, race/ethnicity, BMI, chronic kidney disease, the interaction of age with osmolality, and hysterectomy (women only).

Results

Among the 11 482 total subjects, 9497 (83%—4882 men and 4615 women) had both UI and urine osmolality data. Compared to women, men were less likely to report UI (5.9% vs 18.9%; P < 0.001) and more likely to be dehydrated (33.4% vs 24.0%; P < 0.001). In bivariate analysis, men and women who were dehydrated had less UI than men with adequate hydration (men: 3.5% vs 7.6%; P < 0.001; women: 16.3% vs 20.0%; P = 0.02); however, dehydration was not associated with UI in men (OR 0.2, 95% CI 0.6‐1.0) or in women (OR 0.8, 95% CI 0.4‐1.5) in multivariable models.

Conclusions

Hydration status as defined by urine osmolality was not associated with moderate to severe urinary incontinence in men or women.     

小耳畸形的“二期法”耳廓再造术

目的探讨"二期法"行耳廓再造术的临床应用。方法第1期手术:切取右侧第6～8肋软骨,制成具有三层结构的自体肋软骨支架;应用"双瓣"技术,以残耳根部为蒂,将后方乳突区无毛发的皮肤掀起,形成皮瓣,耳后筋膜瓣的范围扩大至发际线内3.5～4 cm,呈半圆形。将肋软骨支架移植于"双瓣"之间,进行耳廓再造。第2期:利用剩余的残耳组织,重建耳轮脚、耳屏和耳甲腔等耳廓亚解剖结构。将残耳上半部制成"V"形耳轮脚皮瓣;将中部残耳组织制成半圆形耳屏皮瓣。同时将上半部残耳软骨雕刻成圆锥状,与再造耳的耳轮末端缝合固定,耳轮脚皮瓣转位覆盖,形成耳轮脚;将中部残耳软骨修剪成半圆形,用耳屏皮瓣包裹再造耳屏。切除耳甲内多余组织,进行加深,创面植皮覆盖。结果 2007年至2010年,采用"二期法"实施耳廓再造71例。经过0.5～3年随访观察,再造耳位置适当,大小与健侧基本一致;皮肤颜色与面部接近,随时间延长皮肤感觉逐渐恢复;支架无吸收及变形,再造耳廓的立体结构良好、外形自然;颅耳角与对侧相似,耳后瘢痕不明显。结论 "二期法"耳廓再造术简便易行,并发症少,易于推广应用。     

Gender differences in the surgical treatment of lumbar disc herniation in elderly

Purpose

Outcome after lumbar disc herniation (LDH) surgery in middle-aged patient is usually reported to fulfill the criteria for successful outcome. It is also known that women in these years have an inferior outcome compared to men. This study evaluates whether the same gender differences exist in elderly.

Method

In the national Swedish register for spine surgery (SweSpine) we identified 1668 patients ≥65 years. 1250 of these patients had both pre- and 1-year postoperative data registered, 53 % males with mean age 70.6 ± 5.0 (mean ± SD) and 47 % females with mean age 71.3 ± 5.2. All were surgically treated due to LDH between 2000 and 2012.

Results

Before surgery both men and women had severe impairment, compared to normative data, in all patient-reported outcome measures (PROMs), with women having inferior status to men. Improvement by surgery was similar in both genders but neither of them reached normative values in quality of life as compared to normative age-matched individuals. As a consequence of this women 1 year after surgery had more back and leg pain, higher consumption of analgesics, greater impairment in walking distance and inferior scoring in virtually all registered PROMs compared to men (all p < 0.005). In spite of this women were as satisfied with the surgical outcome as the men.

Conclusion

Elderly women with LDH surgery report inferior outcome compared to males, mainly as a result of being referred to surgery with an inferior status but are despite this as satisfied with outcome as the men.