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El-Shabrawi K, Offergeld C. [Medical examination: Preparation for ENT specialisation : Part 73]. HNO 2024; 72:745-750. [PMID: 39186084 DOI: 10.1007/s00106-024-01506-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/27/2024]
Affiliation(s)
- K El-Shabrawi
- Klinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
| | - C Offergeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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2
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Lin Y, Ronde EM, Butt HA, van Etten-Jamaludin F, Breugem CC. Objective evaluation of nonsurgical treatment of prominent ears: A systematic review. JPRAS Open 2023; 38:14-24. [PMID: 37694192 PMCID: PMC10491642 DOI: 10.1016/j.jpra.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background The prominent ear is a type of congenital ear deformity that can be corrected by a variety of nonsurgical treatments, such as splinting and the taping method. However, there is no objective evaluation method that is universally accepted. The aim of this review is to evaluate objective measurement methods that are used in the available literature to analyze nonsurgical treatment of prominent ears. Methods A systematic review was performed in the MEDLINE and Embase databases in December 2022 and updated on April 2023 according to Preferred Reporting Items for Systematics and Meta-Analyses (PRISMA) guideline. Any study using objective measurements (continuous variables such as distance and angle) to evaluate the effect of nonsurgical treatment of prominent ears was included. The Joanna Briggs Institute (JBI) critical appraisal for case series was used for quality assessment. Results A total of 286 studies were screened for eligibility, of which five articles were eligible for inclusion. All of the included studies were case series. The helix mastoid distance (HMD) is the most commonly used parameter to measure treatment outcome. Pinna and cartilage stiffness, length, and width were also used, but without clear statistical relevance. HMD was classified into grading groups (i.e. good, moderate, and poor) to evaluate the treatment's effect. Conclusion Based on the included studies, objective measurements are rarely used, and when used, they are largely heterogeneous. Although HMD was the most frequent measurement used, all studies used different definitions for the measurement and grouped subsequent outcomes differently. Automated algorithms, based on three-dimensional imaging, could be used for object measurements in the nonsurgical treatment of prominent ears.
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Affiliation(s)
- Yangyang Lin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Elsa M. Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Hashir A. Butt
- Bachelor of Science in Medicine, Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands
| | - F.S. van Etten-Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
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Dong L. Vertical mattress suture applied as "Tension band fixation" for the antihelix creation and prominent ear treatment: 104 case reports. J Plast Reconstr Aesthet Surg 2023; 80:36-47. [PMID: 36989881 DOI: 10.1016/j.bjps.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Prominent ears were the most common auricular deformity. Different surgical techniques, such as cartilage-cutting techniques and suturing techniques, are available for treatment. The horizontal mattress suture technique, represented by the Mustard technique, is widely accepted, while the vertical mattress suture technique is rarely discussed in otoplasty. METHOD A total of 104 cases of prominent ear deformities were treated from January 2017 to December 2020. Several hypothetical "tension bands" perpendicular to the natural curvature of the antihelix were introduced for the surgical design and determination of the position of the antihelix fixation, and vertical mattress sutures were placed accordingly for the auricular cartilage fixation. RESULT Follow-up ranged from 3 months to 2 years. No complications, such as hematoma, infection, or poor wound healing, were observed. Three patients had recurrence within two months post operation, and one complained about the overfolded antihelix. Three cases had suture exposure, but the shape of the auricle was not affected after suture removal. The surgical result was evaluated according to the overall shape of the auricle, including the shape of the antihelix, the improvement of the prominent, the surgical marks, and the bilateral symmetry. A total of 98 patients (94.23%) rated the results as "very satisfactory" or "satisfactory". CONCLUSION The vertical mattress suture applied as "tension band fixation" could provide stable cartilage fixation with the natural appearance of the antihelix formation. In addition, the technique could fit a wide range of indications with a low risk of complication and reoccurrence.
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Affiliation(s)
- Liwei Dong
- Department of Plastic Surgery, XiJing Hospital, Air Force Medical University, No.127 Changle West Road, Xi'an, Shaanxi 710032, China.
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Witsberger CA, Michaels R, Monovoukas D, Cin M, Zugris NV, Nourmohammadi Z, Zopf DA. Development of a High-Fidelity, 3D Printed Otoplasty Surgical Simulator. Ann Otol Rhinol Laryngol 2022; 132:607-613. [PMID: 35723201 DOI: 10.1177/00034894221105831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
IMPORTANCE Prominotia has functional and esthetic impact for the child and family and proficiency in otoplasty requires experiential rehearsal. OBJECTIVES To design and validate an anatomically accurate, 3D printed prominotia simulator for rehearsal of otoplasties. METHODS A 3D prominotia model was designed from a computed tomographic (CT) scan and edited in 3-matic software. Negative molds were 3D printed and filled with silicone. Expert surgeons performed an otoplasty procedure on these simulators and provided Likert-based feedback. RESULTS Six expert surgeons with a mean of 14.3 years of practice evaluated physical qualities, realism, performance, and value of the simulator. The simulator was rated on a scale of 1 (no value) to 5 (great value) and scored 3.83 as a training tool, 3.83 as a competency evaluation tool, and 4 as a rehearsal tool. CONCLUSIONS Expert validation rated the otoplasty simulator highly in physical qualities, realism, performance, and value. With minor modifications, this model demonstrates valuable educational potential.
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Affiliation(s)
| | - Ross Michaels
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | - Mitchell Cin
- Medical School, Central Michigan University, Mount Pleasant, MI, USA
| | | | - Zahra Nourmohammadi
- Otolaryngology - Head and Neck Surgery, Pediatric Division, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, MI, USA
| | - David A Zopf
- Otolaryngology - Head and Neck Surgery, Pediatric Division, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Evolution of Anomaly-Specific Techniques in Infant Ear Molding: A Ten-Year Retrospective Study. Plast Reconstr Surg 2022; 150:394-404. [PMID: 35671454 DOI: 10.1097/prs.0000000000009335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital ear anomalies occur in at least one-third of the population, and less than one-third of cases self-correct. Ear molding is a nonoperative alternative to surgery that spares operative morbidity and allows for significantly earlier intervention. In this retrospective study, the senior author developed a tailored approach to each specific type of ear deformity. The use of modifications to adapt standard ear molding techniques for each unique ear are described. METHODS The authors conducted a retrospective, institutional review board-approved study of 246 patients who underwent ear molding by a single surgeon. The procedure reports for each case were reviewed to develop step-wise customization protocols for existing EarWellTM and InfantEarTM systems. RESULTS This review included 385 ears in 246 patients. Patient age at presentation ranged from less than 1 week to 22 weeks. Presenting ear deformities were subclassified into mixed (37.4%), helical rim (28.5%), prominent (10.6%), lidding/lop (9.3%), Stahl's ear (3.6%), conchal crus (3.3%), and cupping (2.8%). Two patients (0.8%) had cryptotia. Deformity subclass could not be obtained for 11 patients (4.5%). Recommended modifications to existing ear correction systems are deformity-specific: cotton tip applicator (CTA)/setting material (Stahl's ear), custom dental compound mold (lidding/lop and cupping), scaphal wire (helical rim), CTA/protrusion excision (prominent), and custom dental compound stent (conchal crus). CONCLUSIONS Presentation of ear anomalies is heterogenous. This ten-year experience demonstrates that the approach to ear molding should be dynamic and customized, using techniques beyond those listed in system manuals to complement each ear and to improve outcomes.
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Siliprandi M, Battistini A, Agnelli B, Bandi V, Vinci V, Lisa A, Maione L, Siliprandi L. Algorithm-Assisted Decision Making in Otoplasty. Aesthetic Plast Surg 2022; 46:207-219. [PMID: 34105004 DOI: 10.1007/s00266-021-02368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Ear congenital deformities represent an aesthetical concern in adult patients and a social matter in children. An accurate assessment of ear defects should be made preoperatively in order to plan surgery adequately. MATERIALS AND METHODS In order to correctly assess the ear preoperatively the authors have considered four different subunits: helical and scaphal region (A), antihelical region (B), conchal region (C) and lobule region (D). Surgical planning should start from sub-unit A evaluation, ending with sub-unit D, in a concentric fashion. When sub-unit A defects have to be corrected, an anterior approach is preferred. DISCUSSION A correct evaluation of ear defects prior to surgery is of dramatic importance. Sub-unit A ear defects are often disregarded, and surgical techniques for their correction are rarely considered. Correcting helical and scaphal defects requires an anterior approach, influencing the technique employed for the correction of subunits B and C defects. Sub-unit B defects should be evaluated and corrected before sub-unit C defects in order to avoid overcorrection of ear protrusion. CONCLUSION Several surgical techniques have been described in the literature for correcting ear defects. After many years of experience, we outlined a schematic flowchart that prevents from leaving areas of the ear untreated, providing the best possible result for the patient. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mattia Siliprandi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20089, Rozzano, MI, Italy.
- Clinica CittàGiardino, Via Francesco Piccoli, 6, 35123, Padua, PD, Italy.
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy.
| | - Andrea Battistini
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Benedetta Agnelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Valeria Bandi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Andrea Lisa
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Luca Maione
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Luca Siliprandi
- Clinica CittàGiardino, Via Francesco Piccoli, 6, 35123, Padua, PD, Italy
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Lopez A, Lyle DA, Brennan TE, Bennett E. Rhinoplasty in a 3 Week Old: Surgical Challenges in the Setting of Severe Congenital Frontonasal Dysplasia. Ann Otol Rhinol Laryngol 2022; 131:1409-1412. [PMID: 35043659 DOI: 10.1177/00034894211072640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Congenital frontonasal dysplasia (CFND) is a rare heterogeneous collection of facial deformities. Due to the range of complexity, surgical management is not standardized. METHODS We present a severe case of CFND and approach to managing multiple defects with a focus on rhinoplasty. RESULTS This infant was born full term with a large mass instead of a nose, a bilateral cleft lip and palate, and hypertelorbitism. Our primary concerns initially were to address communication with the intracranial cavity, preserve a nasal lining, and improve nasal appearance and airway function in the short term without interfering with subsequent rhinoplasty and adult nasal appearance. CONCLUSIONS This complex case of CFND is more severe than anything we encountered in our literature review and demonstrates the necessity for multidisciplinary approach to multiple craniofacial defects. Future plans for this patient include rhinoplasty with auricular graft, scar revision, and addressing tip support.
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Affiliation(s)
- Alexis Lopez
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Daniel A Lyle
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Tara E Brennan
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Erica Bennett
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Outcomes and Complications of the Mustardé Otoplasty: A "Good-Fast-Cheap" Technique for the Prominent Ear Deformity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3103. [PMID: 33133954 PMCID: PMC7544300 DOI: 10.1097/gox.0000000000003103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
Background: The Mustardé otoplasty is a commonly used procedure for the correction of the prominent ear deformity. Complication rates related to suture extrusion and long-term outcomes are variable in the literature. The study’s purpose was to examine the efficacy and safety of the Mustardé otoplasty and its resource utilization, using an “iron triangle” methodology incorporating quality, time, and cost. Methods: Retrospective data were collected on patients under 18 years who underwent primary Mustardé otoplasty between 2009 and 2018. Patient demographics, intraoperative details, complications, follow-up, and satisfaction were collected and analyzed. Results: There were 119 Mustardé otoplasties performed on 68 patients, with a median follow-up of 72 weeks (24–476 weeks). In total, 51 of the 68 patients underwent bilateral procedures. The median operative time was 95 minutes (31–133 minutes), translating to a facility case cost of $2046. A total of 24 complications were reported in 17 patients. Minor complications included the following: suture extrusion (n = 20), hematoma (n = 1), and suture abscess (n = 1). Major complications included reoperation (n = 2). The series had a revision rate of 1.7% (n = 2). No additional procedures were documented at other hospitals in the province. The majority (97%) of ear outcomes demonstrated both patient and surgeon satisfaction. Conclusions: The Mustardé otoplasty demonstrated a high efficacy in the correction of the prominent ear, with low reoperation rates and high patient and surgeon satisfaction. The procedure demonstrated intriguing results in resource utilization, with brief operative times, a “knife and fork” supply chain, and minimal overall case costs. This technique qualifies as a good, fast, and cheap outpatient otoplasty option.
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9
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Smit JA, Coenen DW, van Amerongen EA, Ruhé PQ, Breugem CC. Anterior versus Posterior Scoring of Cartilage in Otoplasty: A Retrospective Patient-related Outcome Measurement Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2900. [PMID: 32766055 PMCID: PMC7339372 DOI: 10.1097/gox.0000000000002900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
Background: Various surgical techniques are applied to correct prominent ears. However, there are limited data on the effect of otoplasty on patient-related outcome measures, such as cold ears and cold intolerance. This retrospective cohort study describes the occurrence of cold intolerance in 98 patients, with a total of 196 ears in a single center during 6 years (2011–2017). Methods: In this study, 3 groups were identified: group I, anterior scoring of the cartilage (ie, Chong Chet); group II, posterior scoring of the cartilage and suture reposition of the cartilage; and group III, posterior approach without scoring (ie, Furnas and Mustardé). Parents of patients filled in a questionnaire with 40 questions to criticize the effect of surgery. Results: Symptoms of cold intolerance and pain were reported in 44.4% (n = 16) in the anterior scoring group, 48.1% (n = 26) in the posterior scoring group, and 62.5% (n = 5) in the posterior approach group without scoring of the cartilage (P = 0.68). The satisfaction rate was significantly lower in the posterior group without scoring (Likert scale of 17.44 ± 22.01 anterior scoring, 16.02 ± 18.13 posterior scoring, and 11.13 ± 25.87 posterior approach without scoring; P = 0.02). Conclusions: This study underscores the fact that a great part of patients after otoplasty report symptoms of cold intolerance; however, these most often resolve and did not differ between different groups. Patients should be informed about this sequela. Furthermore, overall satisfaction rate was significantly lower in the posterior group without scoring.
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Affiliation(s)
- Johannes A Smit
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands.,Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Dominique W Coenen
- Department of Emergency Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - P Quinten Ruhé
- Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands.,Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
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Pausch NC, Pankow T, Lethaus B, Bartella AKH, Halama D. The ideal auricular protrusion - An interactive perceptual pilot study. J Craniomaxillofac Surg 2020; 48:853-858. [PMID: 32709502 DOI: 10.1016/j.jcms.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Excessive ear protrusion (prominauris) can negatively affect facial appearance. Because the concept of an ideal auriculocephalic angle is controversial, however, it is difficult to define when an obtrusive auricle requires surgical intervention. It is often assumed that angles exceeding 30° require corrective surgery. However, little is known about public perception of ear protrusion. This study aimed to assess perceptions of different degrees of auricular protrusion. MATERIALS AND METHODS We conducted an interactive panel survey. Male and female evaluators assessed digitally processed cloned images of a male and female model that depicted various ear protrusions ranging from 0° to 90°. Predictor variables were the sex of the evaluator, the sex of the clone and the extent of auricular protrusion. The outcome variable was the overall attractiveness of auricular appearance. RESULTS Forty-four evaluators (students of dental medicine, mean age 25.43 years) participated in the study: 22 women and 22 men. The study results revealed sexual dimorphism, with the attractiveness of corresponding male and female clones rated differently. Male evaluators favoured female ear positions that fitted closer to the head; preferred alignments for female clones were: 18° (Mean) ± 9.38° (SD), p = 0.006; for male clones: 30° ± 7.94°, p = 0.003. Ear protrusion starts to negatively affect aesthetic appearance for male evaluators at positions of 42° ± 4.87° (female clone) and 54° ± 8.22° (male clone), p = 0.001. The panel of evaluators agreed to perceive angles of 21-24° ± 8.10° (female clones), ± 8.33° (male clones), as the ideal degree of protrusion in both sexes (p = 0.158). CONCLUSION In this study, perception of ear appearance depended on the sex of both the evaluator and the clone being assessed. Obtrusive ears were more readily accepted in male faces than in female ones. Nevertheless, the overall panel perception shows a preference for rather close fitting, unobtrusive ear alignments. For planning of corrective ear surgery, a target angle of approximately 22° can be considered as a desirable result.
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Affiliation(s)
- Niels Christian Pausch
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery (Head: Prof. Dr. Dr. Bernd Lethaus), Faculty of Medicine, University Hospital of Leipzig, Germany.
| | - Tabea Pankow
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery (Head: Prof. Dr. Dr. Bernd Lethaus), Faculty of Medicine, University Hospital of Leipzig, Germany
| | - Bernd Lethaus
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery (Head: Prof. Dr. Dr. Bernd Lethaus), Faculty of Medicine, University Hospital of Leipzig, Germany
| | - Alexander Karl-Heinz Bartella
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery (Head: Prof. Dr. Dr. Bernd Lethaus), Faculty of Medicine, University Hospital of Leipzig, Germany
| | - Dirk Halama
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery (Head: Prof. Dr. Dr. Bernd Lethaus), Faculty of Medicine, University Hospital of Leipzig, Germany
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Wang D, Jiang H, Pan B, Yang Q, He L, Sun H, Yu X, Lin L. Standardized measurement of auricle: A method of high-precision and reliability based on 3D scanning and Mimics software. Exp Ther Med 2019; 18:4575-4582. [PMID: 31807147 PMCID: PMC6878875 DOI: 10.3892/etm.2019.8159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/30/2019] [Indexed: 11/23/2022] Open
Abstract
Objective measurement is important for diagnosing congenital or acquired auricular abnormalities and the evaluation of therapeutic efficacy. However, methods applied in the past were mostly inaccurate and unreliable. The present study aimed to introduce five standardized indices for auricle measurement and present a highly precise and reliable methodology combining three-dimensional (3D) scanning techniques and the Materialise Mimics software for the evaluation of auricle sizes. A total of 20 normal ears were measured independently by four surgeons using the standardized digital method with 3D scanning technique and the traditional manual method. Parameters of the auricle, including the length and width, arc length, cranioauricular height and angle were measured using the Mimics software. Paired t-test, Wilcoxon signed rank test and intra-class correlation coefficients (ICC) were performed on the data to assess the precision, uniformity and observer independence of the method. Pearson's product moment correlation was calculated to assess the correlation between auricle length and width in addition to the correlation between cranioauricular height and angle. No significant differences were indicated between measurements of five auricular parameters made by two surgeons using the digital method. However, significant differences were found using the manual method (P<0.01). ICC values derived from digital measurements ranged from 0.901 to 0.987, whereas those derived from manual measurements ranged from 0.526 to 0.807. These results suggested that the standardized digital method was replicable and reliable compared with the traditional manual method. Pearson's coefficient analysis showed that there was a significant correlation between cranioauricular height and angle (P<0.05), but no correlations were found between the height and width of the auricle (P>0.05). Taken together, data from the present study suggested that measurements of the length and width, arch length, and cranioauricular height and angle of auricles using the standardized digital method combining 3D scanning with the Mimics software were comprehensive, precise, convenient, repeatable and reliable.
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Affiliation(s)
- Di Wang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Haiyue Jiang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Bo Pan
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Qinghua Yang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Leren He
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Hengyun Sun
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Xiaobo Yu
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Lin Lin
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
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Aesthetic Otoplasty: Principles, Techniques and an Integrated Approach to Patient-Centric Outcomes. Aesthetic Plast Surg 2019; 43:1214-1225. [PMID: 31289880 DOI: 10.1007/s00266-019-01441-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Otoplasty is a century-old procedure that, through continued modifications, now has over two hundred different procedures described in the literature. In this article, we seek to describe the anatomy and principles of aesthetic otoplasty, as well as some of the key contributions to aesthetic otoplasty. This article will also outline some of the most commonly used techniques today and associated patient outcomes. METHODS We present a review of the literature of relevant anatomy, pathophysiology and common techniques and outcomes. We also provide a discussion of several patients with associated techniques and outcomes. RESULTS The treatment of prominent ear has developed through manipulation and experimentation. The outcomes are defined by the native anatomy, the surgical technique and the attention to patient-centered outcomes. CONCLUSION Aesthetic otoplasty remains one of the most important surgical techniques and common procedures in plastic surgery. Using an integrated approach guided by known principles as well as patient goals allows for optimal outcome in aesthetic otoplasty. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Treatment of the Prominent Ear: A Standardized Approach Without Intraoperative Measurements. J Craniofac Surg 2018; 30:228-230. [PMID: 30376502 DOI: 10.1097/scs.0000000000004868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Candidates for otoplasty have variable anatomy that may result in an aesthetically suboptimal appearance. The authors describe an algorithm to obtain ideal aesthetic position of the ear using a standardized suturing only technique. METHODS A retrospective review was conducted at a major children's hospital. Pre- and postoperative distances from the mastoid to the posterior lateral helical rim were measured at 3 consistent points (upper helix, mid helix, and lobule). Cosmetic outcomes were determined by visual analog cosmetic score (VACS), assigned by 3 independent reviewers. RESULTS A total of 26 patients underwent otoplasty for prominent ear (average age 8.2 years). Duration of follow-up was an average of 32 weeks postoperatively. Pre- and postoperative VACSs were determined for all patients: overall-appearance, 25.8 versus 71.3; overall-ear appearance, 25.7 versus 70.0; shape, 24.4 versus 72.6; and projection, 23.7 versus 73.9 (P < 0.05 for all). There was no inter-rater difference between scores. There was greater symmetry between ears postoperatively (P < 0.05). Measurements were significantly improved pre- versus postoperatively: upper-helix 2.04 versus 1.20 cm, mid-helix 2.22 versus 1.18 cm, and lobule 1.85 versus 1.49 cm (P < 0.05.) Postoperative measurements are in accordance with established norms for ideal ear position (1.0-1.2 cm upper third of the ear). Two patients recurred, and 1 experienced a spitting suture (11.5%). CONCLUSION Aesthetic ideal was established on the operating table based on the appearance of the ear. Postoperative measurements fell within aesthetic ideal for a normal ear, suggesting that the use of intraoperative measurements are not needed to obtain an aesthetically acceptable outcome.
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Kang NV, Sabbagh W, O'Toole G, Silberberg M. Earfold: A New Technique for Correction of the Shape of the Antihelix. Laryngoscope 2018; 128:2282-2290. [PMID: 29658102 PMCID: PMC6221023 DOI: 10.1002/lary.27197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 11/07/2022]
Abstract
An absent or poorly defined antihelix often plays a central role in the perception of the prominent ear. A wide variety of otoplasty techniques have been described over the last 50 years that aim to reshape, create, or enhance the definition of the antihelix, which can, in turn, help to reduce the prominence of an ear. In addition to conventional suture and cartilage-scoring techniques, a permanent implantable clip system (Earfold® ) has recently become available that is placed using a minimally invasive approach performed under local anesthesia. In this review, we summarize conventional otoplasty techniques to correct the antihelix and compare these with the Earfold implantable clip system. Laryngoscope, 128:2282-2290, 2018.
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Affiliation(s)
| | | | - Greg O'Toole
- Royal Free Hospital NHS TrustLondonUnited Kingdom
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Guo F, Yu X, Jiang H. [Current progress of laser-assisted cartilage reshaping for prominent ear]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:769-772. [PMID: 29905059 DOI: 10.7507/1002-1892.201712074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the current progress of laser-assisted cartilage reshaping (LACR) for prominent ear. Methods The domestic and abroad article concerning the LACR in treatment of prominent ear was reviewed and analyzed. Results As a new technique, there were three types of LACR therapies that been used for prominent ear. LACR with the 1 064 nm Nd/YAG laser is painful and the penetration depth of the 1 064 nm Nd/YAG laser is greater than that of the 1540 nm Er/Glass laser which is caused more tissue injury. LACR with the 1 540 nm Er/Glass laser has high absorption by the ear cartilage and produce less injury to the surrounding tissue. Use of the CO 2 laser permitted cartilage reshaping combined with both vaporization and incisions, which complicates the technique, although, with low recurrence rate and definite effect. Insisting on wearing ear mold is the key to get satisfactory effectiveness for postoperative patients. The complications of LACR for prominent ear, such as the dermatitis, perforation of the skin, hematoma, or infection, should be noticed. Conclusion Application of LACR for prominent ear just has a short period of time, limited number of cases, and few relevant literature reports. Its effectiveness needs to be further studied and clarified.
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Affiliation(s)
- Fengfeng Guo
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China
| | - Xiaobo Yu
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China
| | - Haiyue Jiang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144,
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Punj P, Chong HP, Cundy TP, Lodge M, Woods R. Otoplasty techniques in children: a comparative study of outcomes. ANZ J Surg 2018; 88:1071-1075. [PMID: 29740979 DOI: 10.1111/ans.14386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Numerous otoplasty techniques have been described in the literature to correct prominent ears; however, few have focused on the complication rates. We reviewed our experience aiming to assess peri-operative care requirements and complication rates. METHOD We conducted a retrospective review of 207 otoplasty procedures performed in 119 patients over a 5-year period (2009-2014) at the Women's and Children's Hospital, Adelaide. Information pertaining to demographic details, length of stay, otoplasty technique and complications (early and late) were obtained. RESULTS In the study period, 97% of the 119 patients had an overnight stay. There was an early complication of 2.2% (return to theatre for bleeding) in the modified Chongchet technique and 0.9% (wound infection) in the Mustarde technique. Late complications included suture extrusion (1.9%) with the Mustarde technique and hypertrophic scarring (2.2%) in the modified Chongchet technique. The recurrence rate requiring revision following modified Chongchet technique was 10% and Mustarde technique was 2.9%. The Mustarde otoplasty technique was associated with a slightly lower antiemetic requirement than the Chongchet technique (3.2 versus 14.3%, P = 0.032). Both techniques had comparable opioid analgesic requirement of 30-35% post-operatively (P = 0.248). CONCLUSION Our results are comparable to the huge variation in available literature. We note the higher revision rate following modified Chongchet technique. Both techniques had a low and acceptable rate of post-operative analgesia and antiemetic requirement. We are considering either otoplasty technique as a day surgery procedure within our unit with the provision of adequate patient support as a safe and economical advance.
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Affiliation(s)
- Puvesh Punj
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Hsu Phie Chong
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas P Cundy
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michelle Lodge
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Roger Woods
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Markey J, Mace J, Anderson Y, Wang TD. Hybrid Cartilage-Modifying Otoplasty Technique and Outcomes. JAMA FACIAL PLAST SU 2018; 20:57-62. [PMID: 29167864 DOI: 10.1001/jamafacial.2017.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Otoplasty is performed to correct prominauris, one of the most common head and neck congenital deformities. Advances in combination hybrid approaches enable surgeons to achieve greater precision and accuracy. Objective To describe a hybrid cartilage-modifying approach and evaluate the procedure's effectiveness and safety. Design, Setting, and Participants Medical record review including patients undergoing otoplasty by the present technique from January 2006 to December 2016 as performed by the senior author at a tertiary academic referral center. Twenty-three patients underwent 24 total procedures including both bilateral (n = 17) and unilateral (n = 7) procedures. Two procedures were revisions. Interventions Hybrid cartilage-modifying otoplasty procedure. Main Outcomes and Measures Preoperative and postoperative measurements were recorded. Paired sample t testing was performed to assess changes between preoperative superior, middle, and inferior helical measurements and corresponding postoperative measurements for all operated ears. Two-tailed, independent sample t testing was performed to compare postoperative differences between right and left ears within separate superior, middle, and inferior measurements in patients undergoing bilateral otoplasty. Results Twenty-four surgeries were performed on 23 patients. The mean (SD) age at surgery was 16.3 (13.6) years with 13 patients (58%) between the ages of 4 and 10 years. Preoperatively, the mean (SD) superior, middle, and inferior helical rim-to-mastoid distance of the 41 discrete ears measured 16.5 (3.1) mm, 24.1 (3.8) mm, and 19.3 (4.4) mm, respectively. Mean (SD) postoperative measurements were 12.1 (2.4) mm, 14.7 (2.5) mm, and 14.0 (2.8) mm, respectively, for mean (SD) decreases of 4.4 (2.7) mm, 9.4 (3.4) mm, and 5.3 (3.6) mm. For the 17 bilateral procedures, the mean (standard error) postoperative scores between ears measured 0.7 (0.9) mm for the superior, 0.5 (0.9) mm for the middle, and 0.2 (1.0) mm for the inferior. The unaffected ear was measured in 4 of 7 (57%) of patients undergoing unilateral otoplasty, and the mean (SD) postoperative differences between left and right ears were 1.3 (0.8) mm, 3.0 (1.2) mm, and 1.0 (0.7) mm for the superior, middle, and inferior, respectively. Preoperative-to-postoperative differences for all ears (n = 41) were significant (P < .001 for all) for superior, middle, and inferior measurements. There were no significant absolute differences identified for superior (P = .41), middle (P = .58), and inferior (P = .88) measurements regarding left vs right postoperative comparisons for bilateral otoplasties. One patient undergoing bilateral repair required subsequent revision surgery of 1 ear. Two patients developed chronic suture site irritation, and 1 patient developed a hematoma. Conclusions and Relevance The present technique allows multiple opportunities to adjust the auricular parameters. The results indicate a low revision rate and high degree of symmetry. Level of Evidence 4.
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Affiliation(s)
- Jeffrey Markey
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, New York University School of Medicine, New York
| | - Jess Mace
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Yvette Anderson
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Tom D Wang
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
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Kajosaari L, Pennanen J, Klockars T. Otoplasty for prominent ears - demographics and surgical timing in different populations. Int J Pediatr Otorhinolaryngol 2017; 100:52-56. [PMID: 28802386 DOI: 10.1016/j.ijporl.2017.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prominent ears are seen in approximately 5% of the population. This benign condition can be treated surgically to reduce or prevent psychological and social problems, most commonly in children before the start of school. Our aim was to examine the demographic characteristics of patients undergoing prominent ear surgery in Finland, and compare findings with international data. METHODS A retrospective study of all the patients treated for prominent ears in our academic tertiary care referral center during 2007-2011 was performed to gather demographic details of operated patients. A systematic review of published series of prominent ear surgery after the year 2000 was performed to gather demographic details for international comparison. RESULTS A total of 180 patients were operated in our institution for prominent ears, most of the cases (78.9%) were bilateral. Age at operation ranged between 3 and 36 years, with mean of 9.2 y and median of 7 y. The most common reason for seeking operative treatment was aesthetic complaint, followed by bullying. Review process gathered 20 publications, describing a total of 4433 patients who had been operated for prominent ears. There was wide variation the mean age at operation, ranging 7-38 y while the mean overall was 15.0y. Gender distribution of patient samples was also very variable, with percentage of females ranging from 38 to 71% (overall 52%). There was also considerable variation in the tendency to perform unilateral operations: from 0% up to 21% of the reported population. There were no statistically significant correlations linking these demographic variables, though there was a trend that females are more likely to have this operation performed at an older age. CONCLUSIONS The treatment culture of prominent ear surgery varies substantially in international comparison. The age at which this operation is performed showed most variation. Omitting some of the basic demographic variables while reporting the results of surgery was common in the reviewed publications.
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Affiliation(s)
- Lauri Kajosaari
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Juhani Pennanen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomas Klockars
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Gandy JR, Foulad A, Chao KK, Wong BJF. Injectable chondroplasty: Enzymatic reshaping of cartilage grafts. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:217-220. [PMID: 28209412 DOI: 10.1016/j.anorl.2016.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/17/2016] [Accepted: 05/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE/HYPOTHESIS To develop an injection-based enzymatic technique that selectively softens cartilage tissue for reshaping cartilaginous structures in the head and neck. MATERIALS AND METHODS Two groups were formed using fresh rabbit ears: (1) whole rabbit ear group; (2) composite graft group (2.5mm×3.0cm specimens sectioned from the central region of the pinna). Subperichondrial injections using three enzymes (hyaluronidase, pronase, and collagenase II) in sequence were performed for the experimental specimens from both groups. In the control specimens, phosphate buffered saline was injected in a similar fashion. The whole ear specimens were then photographed while held upright in the anatomical vertical position to evaluate for buckling, which corresponds to the integrity of the cartilage. In addition, backlight photography was performed for all specimens to further evaluate the effect of the enzymes, such that increased light intensity represents increased cartilage digestion. RESULTS The application of the digestive enzymes resulted in marked reduction of cartilage tissue matrix resiliency, while preserving overlying skin layers. Enzymatically treated whole pinnae buckled at the site where enzymes were delivered. Backlit images revealed increased local light intensity at the regions of digestion. There was no obvious destruction of the overlying skin upon visual inspection. CONCLUSIONS This study demonstrates the feasibility of injectable chondroplasty as a potential alternative method to conventional surgery for auricular cartilage reshaping. Sequential injection of hyaluronidase, pronase, and collagenase II into the subperichondrial space can be performed to digest and soften cartilage structure with minimal involvement of surrounding tissue. Future studies will need to include chondrocyte viability testing and optimization of delivery techniques.
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Affiliation(s)
- J R Gandy
- Division of facial plastic surgery, department of otolaryngology, head and neck surgery, university of California Irvine, 101, The City Drive, CA 92668 Orange, United States; Beckman Laser institute and medical clinic, university of California Irvine, 1002, Health Sciences Road East, CA 92612 Irvine, United States
| | - A Foulad
- Division of facial plastic surgery, department of otolaryngology, head and neck surgery, university of California Irvine, 101, The City Drive, CA 92668 Orange, United States; Beckman Laser institute and medical clinic, university of California Irvine, 1002, Health Sciences Road East, CA 92612 Irvine, United States
| | - K K Chao
- Beckman Laser institute and medical clinic, university of California Irvine, 1002, Health Sciences Road East, CA 92612 Irvine, United States; Department of radiation oncology, Epic Care, 400, Taylor Boulevard, Suite 102, CA 94523 Pleasant Hill, United States
| | - B J F Wong
- Division of facial plastic surgery, department of otolaryngology, head and neck surgery, university of California Irvine, 101, The City Drive, CA 92668 Orange, United States; Beckman Laser institute and medical clinic, university of California Irvine, 1002, Health Sciences Road East, CA 92612 Irvine, United States; Department of Biomedical Engineering, university of California Irvine, CA 92612 Irvine, United States.
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Tahery J, Jones GH, Shah S. Pinnaplasty: improved access to the antihelical fold. Clin Otolaryngol 2016; 43:772-773. [PMID: 27992948 DOI: 10.1111/coa.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J Tahery
- Otolaryngology Department, Countess of Chester Hospital, Chester, UK
| | - G H Jones
- Otolaryngology Department, Countess of Chester Hospital, Chester, UK
| | - S Shah
- Otolaryngology Department, Countess of Chester Hospital, Chester, UK
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Technical refinement of Stenström otoplasty procedure. ACTA ACUST UNITED AC 2016; 117:147-50. [PMID: 27160423 DOI: 10.1016/j.revsto.2016.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/04/2015] [Accepted: 01/18/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Surgical correction of prominent ears is a common aesthetic procedure in young children. Stenström technique is widely performed in France. We present some technical refinements that may be associated to this technique in order to allow for a simple correction of the majority of deformations. TECHNICAL NOTE The first step of the Stenström technique is the treatment of the unfolded antihelix if necessary. Our first modification consists in introducing the rasp by an anterior approach, hidden under the upper plication of the helix, allowing for a better control. A second modification consists in a resection of the concha by a posterior approach in case of conchal hypertrophy. A third modification is the burying of the concha by suture to the mastoid periosteum after posterior auricular muscle resection in case of obtuse conchoscaphal angle. These refinements can be performed either separately or in combination according to the deformities to be corrected. DISCUSSION The technical refinements presented may correct almost all the ear deformities. The suture-less technique allows for a natural aspect of the antihelix plication.
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