Otoplasty for lop ears

The classification of malformations of the auricle is reviewed. Hinderer's technique is described. It is based on long oblique skin and cartilage flaps of the upper pole of the ear, taken in opposite directions for expansion of the helical arch, thus preventing a later visible notching at the helical rim. The remaining scapha is straightened and the superior crus and antihelical fold are formed by scratching and sandpaper abrasion of the lateral surface. A deep concha is treated by a cartilage strip expansion from the posterior conchal wall.     

A Simple Surgical Technique for Correction of Macrotia with Poorly Defined Helical Fold

Macrotia is a relatively rare auricular deformity and few techniques for treatment have been described, most of which include skin and cartilage excisions. Effacement of the helical fold may accompany this deformity and should be reconstructed for aesthetic integrity. The authors present their ear reduction technique that achieves ear reduction and helical fold reconstruction through a posterior approach. The method is a simple procedure performed by incising and overlapping the cartilage and should be indicated for selected mild macrotia cases.     

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.     

An effective technique of helical cartilage scoring for correction of prominent ear deformity

Otoplasty has a long history starting from 1948, when Dieffenbach described it first. Multiple technical modifications have been reported since. We propose a technique of scoring the helical cartilage without a visible incision on the lateral aspect of pinna for easier remolding of cartilage through posterior approach. The results have been excellent.KEY WORDS: Helical cartilage scoring, otoplasty, prominant ears     

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.     

Narrow Elliptical Skin Excision and Cartilage Shaving for Treatment of Chondrodermatitis Nodularis

BACKGROUND: Surgical excision remains the hallmark of therapy for chondrodermatitis nodularis chronica (CNC). Although excision is generally successful, recurrence at the edge of the excised nodule is well recognized. OBJECTIVE: To analyze the clinical features and the recurrence rate of patients with CNC treated with elliptical excision of the papule and removal of the underlying cartilage. DESIGN: Seventy-four outpatients with CNC, 52 men and 22 women, were retrospectively analyzed. A narrow elliptical excision of the papule followed by a slice of the underlying cartilage were carried out with local anesthetic. Cartilage spikes were trimmed carefully shaping a smooth contour from the normal helical rim to the defect. RESULTS: Good cosmetic results were obtained in all patients. The median follow-up for helical and antihelical lesions were 54 and 50 months, respectively. The global recurrence rate was 13.5% and ranged from 10.6 to 37.5% for helical and antihelical lesions, respectively. CONCLUSIONS: We recommend this surgical procedure because it has been shown to be as efficient as other methods and probably faster to perform.     

A simple operative procedure for the treatment of Stahl's ear

Stahl's ear is a rather rare congenital deformity and operative procedures for its correction have seldom been reported. We recently devised a simple method of surgical treatment, which is briefly described as follows: incisions are made into the third crus cartilage to facilitate the formation of a helical fold, and the cartilage is sutured by means of a mattress suture. This method makes it possible to produce a natural helix, though it fails to eliminate the third crus.     

The elevation of the constructed auricle with a temporoparietal fascial flap wrapping a resorbable plate.

During the second stage reconstruction of the auricle in patients with microtia, we modified Nagata's method and two technical improvements were possible. After the implanted auricle was separated from the bed, we harvested the temporoparietal fascial flap through helical rim incision instead of incising the temporal scalp. So the surgical scar over the temporal region was avoided. Thereafter, a costal cartilage wedge was carved and grafted to the posterior aspect of the conchal region to get a firm projection. But in cases of unavailable costal cartilage wedge graft, we used a resorbable plate composed of polylactic and polyglycolic acid as a substitute for the former so that we could create firm elevation and sufficient ear projection. Between June 2002 and May 2004, 28 patients underwent this operation with the temporoparietal fascial flap and resorbable plating system. There was no complication resulting from our technique. It was possible to create firm elevation and good frontal projection even if there was no available cartilage wedge. Additionally, by harvesting the temporoparietal fascia through helical rim incision, we avoid creating additional scars on the scalp.     

Cryptotia repair: a modern update to the trefoil flap

Cryptotia is a congenital anomaly in which the superior aspect of the helical cartilage is buried beneath the scalp, resulting in an absence of the auriculocephalic sulcus. Treatments have included splinting, skin grafts, and a variety of local flaps. We present a modification of the trefoil flap, initially described by Wesser in 1972. The modifications include wider undermining of the opposing trefoil flap (≤ 2-4 cm), staggering the closure of the helical apices, and expanding the base of the auricular trefoil flap such that it extends over a larger circumference of the helical rim. The senior author (K.S.) has achieved excellent results with this method and has alleviated the need for skin grafts or local preauricular flaps to close the donor site.     

Redefinition of the helical rim in cauliflower-ear surgery.

Cauliflower ear is a serious deformity of the auricle induced by single or repeated injury to the external ear. Few papers deal with surgical techniques for correcting this deformity. We describe the use of ipsilateral excess cartilage to restore the helical rim.     

“Anterior Scoring of the Upper Helical Cartilage as a Refinement in Aesthetic Otoplasty”

Background Anterior scoring with the use of simple or dedicated instruments, toothed forceps, endoscopic carpal tunnel release instruments, and needles has been described previously. The upper third of the ear easily maintains the original shape because memory and elasticity are stronger than in the middle or the lower part of the ear. This report describes a further refinement to the Chong-Chet anterior scoring technique, consisting of anterior scoring of the upper helical cartilage to correct the helical radix upper prominence.Methods A retrospective study analyzed 20 surgeries for prominent ears. All the subjects had undergone otoplasty softening the helix.Results There were no residual ear prominence/upper third prominence or cartilage irregularities at the 1-year follow-up evaluation. Anterior auricular cartilage scoring is an effective technique for controlling the degree and position of the antihelical fold. Furthermore, the upper third of the pinna seems to have a stronger memory than the middle third. To prevent this late complication the authors routinely perform anterior scoring up to the helix, weakening that cartilage usually untouched with other procedures.Conclusion This refinement, in combination with other procedures is safe, easy, and fast, giving reproducible and good aesthetic results.     

Reconstruction of full-thickness ear defects using conchal cartilage and pedicled temporoparietal fascia

We describe method for reconstructing full-thickness ear defects using conchal cartilage graft covered by a pedicled temporoparietal fascial flap with a full-thickness skin graft. We treated eight partial, full-thickness defects of the ear in eight patients, two males and six females. The patients' ages ranged from 10 to 68 years. In five patients, the ear defects were caused by malignant tumor resection (three) and trauma (two). In the remaining three patients, the defect was created after correction of congenital ear deformity (constricted ear). In all cases, the defect included the helical rim and involved the upper third of the ear. The defect size to be reconstructed ranged from 10×14 mm to 16×20 mm. The ipsilateral conchal cartilage could be harvested without any problems in all cases. Grafted skin was obtained from the lower lateral abdomen. In all cases, the blood supply to the fascial flap was good, and the grafted skin took completely. The post-operative course was uneventful in all donor sites for cartilage, temporoparietal fascia, and full-thickness skin. Post-operative shrinkage was not significant and the reconstructed ear was close to the expected contour and size. In all cases, the defects were reconstructed almost completely satisfactorily in terms of contour of the helical rim and support. Although the color match of the grafted skin was not ideal, all patients were satisfied with the results. No donor deformity of the conchal cartilage was found in any case, and the donor scar of the temporoparietal fascia was hidden by the hair. We conclude that the use of conchal cartilage graft and temporoparietal fascial flap with full-thickness skin graft is useful in one-stage reconstruction of medium-sized full-thickness defects of the ear.An invited commentary to this paper is available at     

Alternative splicing of exon 12 of the COL2A1 gene interrupts the triple helix of type-II collagen in the kniest form of spondyloepiphyseal dysplasia

An autosomal dominant mutation in the COL2A1 gene was identified in a child with the Kniest form of spondyloepiphyseal dysplasia. A C to T transition at nucleotide 35 of exon 12 changed the codon GCG for alanine 102 of the triple helical domain of α1 (II) chains of type-II collagen to GTG for valine. The transition also introduced a GT dinucleotide into exon 12. Analysis of cDNA prepared from Kniest cartilage showed that in vivo the transition resulted in an alternatively spliced mRNA that lacked the 21 3′ nucleotides from exon 12. The cartilage cDNA contained approximately equal amounts of normal cDNA and shortened mutant cDNA. The deletion of 21 nucleotides from the mutant cDNA maintained the translational reading frame but resulted in the loss of alanine 102 to lysine 108, which interrupted the repetitive glycine-X-Y triplet sequence required for formation of the triple helix. Type-II collagen molecules containing one or more mutant chains were expected, therefore, to contain interrupted triple helices with a short amino-terminal helical domain A and a large carboxy-terminal helical domain B. Kniest cartilage contained a reduced amount of pepsin-solubilized type-II collagen that consisted of overmodified α1 (II) chains. Peptide mapping showed that the overmodifications extended to the carboxy terminus of the α1(II) chains. Pepsin digestion also yielded shortened α1 (II) chains corresponding to helical domain B, Kniest chondrocytes cultured in alginate beads produced type-II collagen that was not stably incorporated into the pericellular matrix. This study highlights the importance of dominant negative mutations of COL2A1 in producing Kniest dysplasia.     

正常步态下距骨关节面接触特征的有限元分析

[目的]通过有限元法分析正常步态下距骨各关节面软骨应力变化,了解各关节面软骨应力分布的生物力学特征.[方法]利用正常男性的足踝部螺旋 CT 扫描数据,运用三维建模软件,建立足踝部三维几何模型,并对其进行有限元网格划分,分析正常步态下距骨各关节面接触应力及 Von Mises 应力分布.[结果]建立包括骨、软骨、韧带在内的正常人体足踝部三维有限元模型,共21 865 个节点、73 440 个单元,较客观地反映了人体足踝的解剖结构和力学特性.不同位相距骨各关节面接触应力及 Von Mises 应力分布区域和应力值不同.[结论]采用有限元法分析关节软骨应力的生物力学特征是一种可行、有效的方法.     

Tissue-engineered trachea from sheep marrow stromal cells with transforming growth factor beta2 released from biodegradable microspheres in a nude rat recipient

OBJECTIVE: The purpose of this study was to evaluate the feasibility of using autologous sheep marrow stromal cells cultured onto polyglycolic acid mesh to develop helical engineered cartilage equivalents for a functional tracheal replacement. We also explored the potential benefit of local delivery of transforming growth factor beta 2 with biodegradable gelatin microspheres. METHODS: Bone marrow was obtained by iliac crest aspiration from 6-month-old sheep and cultured in monolayer for 2 weeks. At confluence, the cells were seeded onto nonwoven polyglycolic acid fiber mesh and cultured in vitro with transforming growth factor beta 2 and insulin-like growth factor 1 for 1 week. Cell-polymer constructs were wrapped around a silicone helical template. Constructs were then coated with microspheres incorporating 0.5 microg transforming growth factor beta 2. The cell-polymer-microsphere structures were then implanted into a nude rat. On removal, glycosaminoglycan content and hydroxyproline were analyzed in both native and tissue-engineered trachea. Histologic sections of both native and tissue-engineered trachea were stained with hematoxylin and eosin, safranin-O, and a monoclonal anti-type II collagen antibody. RESULTS: Cell-polymer constructs with transforming growth factor beta 2 microspheres formed stiff cartilage de novo in the shape of a helix after 6 weeks. Control constructs lacking transforming growth factor beta 2 microspheres appeared to be much stiffer than typical cartilage, with an apparently mineralized matrix. Tissue-engineered trachea was similar to normal trachea. Histologic data showed the presence of mature cartilage. Glycosaminoglycan and hydroxyproline contents were also similar to native cartilage levels. CONCLUSIONS: This study demonstrates the feasibility of engineering tracheas with sheep marrow stromal cells as a cell source. Engineering the tracheal equivalents with supplemental transforming growth factor beta 2 seemed to have a positive effect on retaining a cartilaginous phenotype in the newly forming tissue.     

Reconstruction of the retroauricular fold: a personal technique.

In auricular reconstruction emphasis is placed on carving the rib-cartilage framework. The three-dimensional frame is very important in obtaining a good anatomical shape but often a good shape is not complemented by a good projection of the auricle. In order to avoid obliteration of the retroauricular fold we use a cartilage wedge covered by a local fascial flap. We have treated 17 ears in 16 patients with this technique and have obtained satisfactory results in all cases, achieving a mean projection of 1.7cm between the mastoid plane and the helical rim.     

Use of vascularised cartilage as an additional interposition in temporomandibular ankylosis surgery: Rationale, advantages and potential benefits

Context:

Surgery for the release of temporomandibular joint (TMJ) ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw.

Aims:

We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint.

Settings and Design:

There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA), which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint.

Materials and Methods:

Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid.

Results:

The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained.

Conclusions:

The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.     

The incision-excision technique in minor auricular deformities

In 1972, in the search for a method to cope with all deformities in protruding ears and other common minor auricular deformities, Claus Walter published a surgical technique based on various incisions and excisions of the cartilage. The procedure consists of a complete separation of the auricle into two parts, combined with remodeling of antihelical, helical, and lobular structures without use of adjusting sutures. Thus, even in patients with stiff and unyielding cartilage and in revisional surgery, pleasing aesthetic results may be achieved. The recurrence rate has found to be reduced markedly. Considering all pros and cons and optional surgical modifications, the incision-excision technique can be adopted for every protruding ear as well as for lop ears, moderate cup ear deformities, and secondary revisions. Because of the extent of cartilage dissection, this technique is not recommended for beginners but should be restricted to experienced surgeons with profound knowledge of basic remodeling procedures.     

Ear reconstruction with a flap from the medial surface of the auricle

Correction of defects of the external ear following trauma or partial amputation for cancerous lesions is difficult. A flap from the medial surface of the auricle has been devised to correct the deformity. The flap is either introduced through the cartilaginous framework or passed around the edge of the helical cartilage for reconstruction of the lateral surface of the ear. The small part of the flap that passed underneath the auricular skin or through the auricular cartilage is deepithelialized. Six patients have been treated with this technique; they have had at least one year of follow-up and good postoperative results.     

Two-Lobed Advancement Flap for Cutaneous Helical Rim Defects

BACKGROUND: Bilobed flaps, transposition repairs used primarily on the nose, recruit tissue from an area of laxity via rotational motion. A variant of the bilobe, the two-lobed flap based on the W-plasty, is a transposition flap that shifts tissue predominantly via advancement. OBJECTIVE: To apply the two-lobed advancement flap to the problem of reconstructing cutaneous helical rim defects of the ear. METHODS: Helical two-lobed advancement flaps were designed and implemented to correct small- to medium-sized defects. RESULTS: The ear helix was successfully repaired with two-lobed advancement flaps. There was minimal distortion of the ear architecture or cartilage, and blood supply was sufficient to ensure flap viability. CONCLUSIONS: In selected cases, cutaneous helical rim defects of the ear can be aesthetically repaired with a two-lobed advancement flap derived from the posterior auricular surface.